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��.�;PPLICATION FO::�' <br />tMENrpn�n VCONST�UCTION <br />utt or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />❑ SI(iN <br />OWNER MMl �DORESS CIIY IIP PND4E <br />\ <br />�RCHITECTOR�ESIONEN MML�DDRE55 CITV 21P PN�NE <br />GENEPA� LONiFALTOR MAIL �ODRESS GITY 2IP PHONE LIGENSE • <br />MFCHANIC�L CONTR�GTOq MAIL �O�RESS CIiY ZIP VHONE LICENSE • <br />PLUMBINGGONTRACTON M�ILAf10RE55 CIiY ZIP� PIIONE LICENSE• <br />CLASS OF WOHK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFPL.INSERT ❑ BUILDING RELOCATION <br />VA WATION OF WORK �COST OF M�TEPI�lS PW 5 UBORI <br />DESCNIBE WOPIt <br />USE OF <br />I FlEREBY CERTIFY THAT I HAVE READ AND EkAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND OR9INANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTINd OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANY OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNA7UflE OF CONiRAGTOR OR AUTN�IR12EU AGENT OATE <br />X ,�r _ _ d.. , fD ,� 0.�,�,/ <br />THIS PORTION TO BE COMPLETED EiY BUILDING DEPT. PERSONNEL <br />