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p a�'�' <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />..PPLICATION FO.. <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PlEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUM@ING ❑ SIGN <br />OWNEN M�R�pORE53 CI1Y IiP GHONE <br />n7_ _ � � _ �� _r � � _ . �. � . <br />PLUMltNQCONTR�GIOH M1t��D�RES$ �ITY ZIP PIIONE LICEHSE• <br />� NEW ❑ ADDITION ❑ ALTEtiAT10N � REPAIR ❑ �EMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V�lUQ10N OL WOFK i�09 Of M�IERIeIS PW 5 L�BORI <br />l�✓4//' (i(� <br />DESCN18E wORR <br />SI:.E <br />r�vi <C - S, <br />IF PpOVf.RTY�SNOWN BElO <br />�ov.D�� <br />Y1 '� '� _ <br />�� -s,S1-a'v', <br />c' <br />/ D.a.�.� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CGRRECT. ALL <br />PRpVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TVPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GNANTING OF A PERMIT DOES NOT PRESUME t0 <br />GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULAi1NG CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATUREOFCONLRRCiORORAUiNORIZEDnGENi ORTE <br />X .� ,��,,,`/�., :� �iy-�G <br />AIR <br />P. EA. <br />M <br />THIS PORTION TO BE COMPLETE� BY BUILDING DEPT. PERSONNEL <br />20NE <br />ic�nonecc er <br />� � f' <br />RRE� <br />ND Oi <br />sioE <br />VpCRN154C <br />OYES pN0 <br />NO.OF �WEI <br />FORISSU�NCE 8Y <br />BUILDINCa <br />{'LUMBIN� <br />MECIIANICAI. <br />OTHEA <br />PENALTY <br />iOTAL <br />FEE <br />� Q rc[ �/ b`p IIECEIPT NO �i' �(\ 1 <br />`i � p � V <br />FEEB V11lUATION — FE� <br />f <br />