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CITY OF EVERETT <br />DE, PARTMEINT OF CONDIUNITY DEVELOPMENT <br />BUILDING P171UIIT APPLICATION <br />f)ATE <br />ADDRESS 01: CONSTUCTION WORK <br />LEGAL DESCRIPTION: LOT BLOCK <br />UNPLATTED DESCRIPTION: <br />BUILDING DESCRIPTION: NEW ADDITION <br />OCCUPANCY OR USH, <br />PE IMIT NO. <br />VALUATION <br />PERMIT FEE <br />PIAT <br />ULICUTS IN STORIES <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: YES <br />CONTRACTOR 12 OWNER <br />MAILING MAILING <br />ADDIUM ADDRESS <br />— ?M�A-A;7r <br />PHONE NIMER 355- / '73 0 PHONE NUMBER <br />c;r REPAIR <br />NO <br />CONTRACTOR'S LICENSE NUMER -L- 2- -;� — 0 *?, - -/ 2 ?�7 <br />SIGNATURE <br />NOTE: THE APPLICANT SHALL FILL IN ALL ABOVE BLANI(S COHPLETELY INCLUDING Till," PLOT PLAN <br />SKETCH ON REAR OF THIS SUEET. * THE APPLICANT IS 103SPONSIB1,13 FOR ALL INFORILMON UMICH <br />IS 17MMISHED Oil T11E APPLTCXF10N. ANY CHANCES IN WE INFORMATION, L&N OR EUILDING <br />PJANS SHALL BE SUBMITTED TO TIM INSPECTION DIVISION FOR APPROVAL B�Llroo` ZOCEED�NG <br />r <br />WITH THE CONSTRUCTION WORK. <br />APPROVAL: k1 <br />1. PLANNING DATE <br />2. ENGINELRI;�G <br />TRAFFIC DIVISION <br />I R SERV <br />?ATr -ICE <br />SINILl', SERVICE <br />PUBLIC SERVICE'SECTION <br />3. INSPECTION LEPARTM.NT <br />4. FIRE MARSHAL <br />�/// ) / -7 � - <br />NOTE': ALL CONSTRUCTION WORK SHALL COMPLY WITH APPLYCABLE. CODES, NOTES ON DRAWINGS, AND <br />INSPI70TIONS <br />