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everett <br />BUILDING DEPARTMENT <br />259-8745 <br />�PPLICATION FO��r�� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />�LITION, ,. ❑ COMBINATION �BUILDING ❑ MECHANICAL <br />�M�ILAODRESS pry Z�p, <br />:!G i 1� ' � � ��iKt`T t-i7 �'/..._�.:/�'. •.cde�-,. <br />e�dT�2ua� k�ra�fi�,q Ls /�- <br />CONTMCTOR _ ' _ M�ILA ORESS <br />21P <br />❑ PLUMBING <br />PHONE <br />7 �5 � � <br />everen <br />�. <br />❑ SIGN I <br />PLUMBINOCONTMCTON MAIL�DURESS CITY 21P PIIONE �ICENSP• I <br />C,L,,�/93OF WORN � <br />ld NEW ❑ ADDITION ❑ qLTERAiION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br />�U�TIOCN OF.'diUFK',�CwOST OF M�TEPIAL9 PLUS L�BOHI I <br />��VJ /1 �/YJ. ' � <br />C <br />sa;,/7 e�Ti�-� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXA.MINED THIS AR <br />PLICATION AND KNOW THE SAME TO BE TRUE ANI� CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDI�:ANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THr �pOVISIONS OK <br />ANYOTHERSTATEORLOCALLAWREGUI ^-`;p! :ONSTRUCTION <br />OR THE PERFORMANCE OF CONS i RUr,TION. ' <br />$I�NATUREfOF�' TR�CTORORAUTppq¢[DACENI DATE <br />X ,!� ' . / ��. . _. .. . <br />MFTAL FIFEPLACE d <br />hp <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />NEAq SETB�CV <br />I 2� / <br />E LOT�REA <br />� ` <br />J <br />�G:�=T� OCCUP�NCYGF <br />.%. N ,Y., <br />I��a+77p NO.OFSTONIE9 <br />��(I'\• I /,� <br />7.S � <br />V�CANT SITE <br />OYES ONO <br />NO.OF OWELLIN011 <br />/ <br />M�X OCG LOAO <br />K� /�, <br />�PPR. FOfl ISSUANCI <br />G� <br />�� <br />BWLLIN� <br />PLUMBINQ <br />MECNANICAI <br />OTNER <br />PENAITY <br />TOTAL <br />� � FEt �Z/�� RECEIPTNf�' <br />.� <br />FEES VALUIITION F[E <br />s /�fil./l /. <br />S7Yzu�?u2� 5�v �laY <br />� 2 � �j- i�c.6 f�l..f�; <br />L�7.a�4.�i.y•_: -, �.�.T,._n-._ . _ _ .?r � - �nj�, �- <br />'_ T..T .3:��i:s <br />�i <br />