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fM ErMpnM <br />�� <br />everett <br />BUILDING DEPARTMENT <br />259•8745 <br />. <br />�PLICATION FO ��' <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />everett <br />e <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIfiN <br />OWNER M�IL�ODRESS CITY ZIP PH�NE <br />Ted R. Provenchec 617 Olympic Blvd. Etrerett 252-4421 " , <br />�RCMITfCTORDE610NER M��LApONE99 �in' ZiP PNONE <br />OENEMI GONiRACTOR MAIL ��ONESS CITY ZIP PHONE LICENSE • <br />Et+erett Bldrs. Inc. 5606 Et�ergreen Way �erett 98203 353-7161 EVIItEB*301PH <br />MECMiViIGALCONTPAGTOR MMLADORE64 Gltt 21P PMONE L�CENSE• <br />KUM�INOCONTMCTqI MAIIADDPE49 ��n' Z�P PNONE LICENSE• <br />❑ NEW ❑ ADDITION I}� ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO RELOCATION <br />VALWTION OF WORIt 1�6T OF M�TEPIAIS PLU! �ARORI <br />5,844.00 <br />10' x 24' <br />�or�uoc �Dor �-00 <br />617 Olympic Blvd. <br />Everett <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNO W TH E SAM E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES CiOVERNI NG THl9 TYPE <br />OF WORK WILL BE COMPLETED WITH WHETrIERSPECIFIED HERE- <br />IN OR NOT. THE ORANTINQ OFA PERMITOOES NOT PRESUME TO <br />OIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br />ANY OTHER STATE OR LOCAL LAW REOULATI NO CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />91ON�NRE Of CONiR�CTOR OR AUTMORIZED �OENT O�1E <br />/� � . � . . <br />X <br />�Z <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />LOT�RE �� / <br />AC�TIONACC.BV VL�NSCHECNEU <br />� � � <br />/ <br />V�GANT ITE <br />orEs o <br />NO. OF D WEILINU UNITS <br />i <br />G -G . <br />PL�N <br />BUILDINO <br />PLUMBIN6 <br />MECHANICRL <br />OTMER <br />FEN�LTV <br />T0T11L <br />IMBEP �PL�'iCHEGKiF.k <br />�/)/�/1 FE�/J��� RECFIPTNO.�/_`%/�f <br />� �G `� � �� � �0 <br />FEE! V�LU�TION F[E <br />s Ci�'/Li_ XL- IDT J <br />