Laserfiche WebLink
�":;� <br />,�.E»ro� ��PPLICATION FO��t ���,�n <br />«TM°F CONSTRUCTION e <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PIEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br />OWNER MML�DDRESS CIfY ZiP PNONF <br />pci-ui V✓� �G��vv.c�er ISC�U7 oY� �d, :v�r, ��29G :3.3�i-o25'% <br />SIpNER M�ILADDRESS <br />owne ✓- <br />M1Vl I�VYXCJJ <br />�1UVXCJi <br />zm <br />VII♦ G�1 <br />• <br />❑ NEW ❑ AODITION � ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING REIOCATION <br />V�LU�TION Oi WORIt IC09T OF M�TERIAlS PW 5 L�BORI <br />OESCRIBE WONK <br />�a,N�yi•y' �r�. <br />—a�o� <br />•�DRE53 <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WFtETNEq SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS O� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUC710N. <br />SIGYAiURE Of CONiRACTOR OR AULNOqIZED AGENT D4IE <br />x�ct:.'rtn N� ,`S;E�Jz��Y�-�— ��, 2 �S <br />�PPLIL�NTS GTV BUSINESS LICENSC NO <br />UNII <br />T u. M <br />EA <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />RE�RSETBACR Si0E5EtBACK PL�NC��ECKNUMpG(1 �'�^�����ECK <br />�NE� <br />PUN9 GHEGRED BY <br />V�C�NI SITE <br />pYES ONO <br />�PPB FOR ISSU�NC[ Ov <br />BUIl01N6 <br />PLUMBING <br />MECIIANICAI <br />O7HEfi <br />PENRLTY <br />TOT11l <br />FEES <br />IEE I�F.CUPiNO <br />{ <br />V�LU�tION � iEE <br />S <br />D C� <br />CJ <br />old� <br />y <br />H <br />� <br />H H <br />H '+7 <br />H r] <br />�t: <br />O <br />� <br />�� <br />Z <br />� � <br />� N <br />'O*J � <br />� H <br />N <br />� <br />. � <br />Z <br />� <br />H <br />� <br />�'] <br />M <br />� <br />