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IM Er+NM^ <br />ptY Of <br />everett <br />BUILDING DEPT. <br />259-8745 <br />' ,-�PPLICATION F4•- ��e <br />CONSTRUCTiON <br />PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT � <br />❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBINCi ❑ S��iN ' <br />��� Z�p PMONE � <br />M�i��oonEss ... _._ ._ � r.,... ..; ��U_ L i� S? <br />ALCONTP�GTOR MqL �DOntns : <br />I <br />w Z�p PHONE IICENSE• ; <br />MAIL �D�RESS ��TM <br />INIGL WNTMC OR n I� L AA'E ST E/( E N S 7S'.�I S' 33 �/- 4// / , <br />rGT �C�7-•����� /!' /� /�%u��� PMONE LICENSE ' <br />IINOCONiMCTOR M�ILAOOHE53 ,� � <br />1 � <br />I OF WORK <br />N�A/ ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILUIN(i RELOCIITION <br />iIION OF VYONK(COST OF M�TEH�AL9 PlU4 LABOf1� <br />� � � ' l•O . <br />I HEREBY C <br />PLICATION <br />PROVISION <br />OFWORKN <br />IN OR NOT. <br />OIVE AUTH <br />ANY OTHEi <br />OR THE PE <br />SION�7URE I <br />X ,i, <br />� <br />=RTIFY THAT I HAVE READ AND EXAMIP <br />,ND KNOW THE SAME TO BE TRUE AND C� <br />LL BE COMPLE ED WITH W ETHER SPE <br />fHE GRANTI NG OF A PERMIT DOES NOT i <br />STATE OR LOCAL L�AW REOULA INO CO <br />iFORMANCE OF CONSTRUCTION. <br />CUNTRACTOF Ofl AUTNORIZEO AOENT 011TE <br />3 AR 61 <br />ALL .I <br />�YPE � <br />ERE <br />ISOK �,� <br />TION <br />PERMIT s TOTALFEE s -� <br />TOTALFEE � � <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL ; <br />p��NCHECKFEE r <br />IT9E79�CN , RE�H9ETB�CN, SI�ESETB�C' FUNCNECNNUMBEF iA qECE1PTN0. %w.�O� k <br />� G � � 1� FEE 4L� LVOa <br />VAWATION �« �`I <br />= LOTAPEp � � V�GANTSITE . FEE! k{S <br />� �i1flS ONO +� <br />r <br />iOFGON4T. OCCUP�NLYGROUP NO.OFDWELlIN0UN1T9 Q� � <br />s � <br />, �_'3 euaoiNa __ <br />NO.OF STORIE9 M�%.OGC. IOAD G ; <br />.OFBLDO. ` _ PLUMBIN6 � <br />:� / � <br />�\ 'O�. 1 <br />MECHANICAL , <br />IE BPRINKLERS REOUIRED ❑ YES �� pTHER � � " � �� ' <br />s <br />FEt�b ._� • � � .') <br />'LICATIONACC.BY PLANSCHECNEDBY �PPR.FORISSU�NGEBY <br />TOTAL <br />`1M� ��� . �53�c� <br />,� ,`'�,' <br />. � : �:� <br />� �. <br />