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p �,,,,,,,,, :��PLICATION FO1,� <br />CONSTRUCTION <br />everett PEf�MIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION �'6UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNE�i MAILAppqE9S LIfY ZIP VMONE <br />�hN Co. <br />WECN�NiC�LLONT1UCfON MM� <br />�DORE94 <br />7215 1�STN <br />WA. <br />Su��ic- <br />L�CFNSE • <br />%UMlINUCONIfUCiOq M�II�DORESS CItY 21P PIIOHE tKENSE• <br />GUSSOf WppR <br />� NEW L� A�DITION ❑ AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDI.YG FELOCATION <br />V�W���ON fWpRN�CO510FM�lERiALSP�USL�lOI� <br />� io,noo.av <br />DESCRIeE WOAK <br />�p,uiw wnQKsNon�d�� <br />UbE O� PURDINO ^ . <br />y�p p�,�pr I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />.� <br />PPOlEC1�ppRE55 <br />251 S <br />w oqov <br />viu��r�o Bwu_ ev�►z�r. <br />NO. TYPE OF <br />_ WATERCLOSET�TOILF.Ij. <br />PLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS 1 YPE <br />OF WORK WILL BE C^MPLETED W�TH WHETFiER SPECIFIED NERE• <br />IN UR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHEii STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEFlFO MANCE OF CONSTRUCTION. <br />SIGNAiUREOFC R�CTORORAUIHORIIEOAGENT DRTE <br />X lL ���G'�`�Y�'Lk '. /I o /RG, <br />EA <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />�I �AONfSEtB�CN BE�HSE1BeCN SIOESETB�CK PL�NGNECI(NOMflER PUNCMECNfEE <br />/ � <br />, /�'•. � � & � �`r_ /'�9 ^1 fEE �� �ECEIPIN� <br />Q �D VO� oC <br />u5E20NE lOi�OE� <br />I'. '� �/I U��� O ES []NO FEES V�LU�TION FEE <br />1 <br />�YFEOFCON51. OCCUPANGYGBOUP NO.OFDWEllIN0UNC5 <br />i tiiLE <br />I .1VPliC�110N <br />or <br />�J � <br />BUILDINQ <br />PLUMBINO <br />MECHANICRL <br />OTHEA <br />PENRITY <br />i. FOR ISSU�NLE PY <br />G. � TOTAL — <br />r� <br />C <br />