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rn. e..ror»n <br />GTY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8745 <br />.PPLICATION FO,_ <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br />f�YNER � M�ILAODPE53 Cltt 21P PNONE <br />II,�AL�S Af17t� C� LlN�C o2'.708 M�bncCr$LL <br />AqCNIIELTONUES10NlR M�ILADDRE53 Gltt 21P PnONE <br />GENEHIILCONIR�GIOF MML�OORE55 CILV ZIP VMON[ UCENSE• <br />��GG� � H�QMots�cr <br />MECIUNIWLCONiR�LTOB M�ILADUHE55 CIiY 21P P110N[ IICENSE• <br />PWMBINQCONTR�CTOR M�ILADORESS CI1Y 21P PnONE UCENSC • <br />NEW ❑ ADDITION ❑ ALTERRTION ❑ PEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RE�OCATION <br />OCSCRIBE WOflN <br />USE 20NE <br />SiEE OF BlDO <br />e <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIiIS AP• <br />PLICATIONAND KNOW THE SAME TU BE TRUEAPID CORRECi. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PFiESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUC110N. <br />SIONATUREOFCONiRRCi ORAU7 RIZEU�GENT [7�TE <br />x �,,j�j,����� <br />PPLIC�NTSCIIYBUSINE554CENSE O <br />�rza:n:ira_i� <br />UNIiS—H. <br />THIS PORTION TO BE COMPLETED BY BUILOING DEPT. PERSONNEL <br />�PEA <br />OF SIOPIES <br />V�CANT SITE <br />OYES ONO <br />OCC. IO�D <br />APAlIC�110N �CC BY I P�ANS GHECNEO BY � APPR. i0R ISSU�NCE BV <br />'UN LIIECN HUMBER PL�N CMECN f EE <br />iEE �ECEIPT ND <br />FEE9 V�LU�TION FEE <br />BUILOINO f � <br />PIUMBING <br />MECHANICAL J � <br />OTMER <br />PENRLTY <br />TOTAL _ � Cli� <br />