Laserfiche WebLink
�PPLICATION FOt:;.) <br />'"'E"ro'"" CONSTRUCTION <br />GIiY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />469.gq.y� y5q-Y)a� TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATIO"7 ❑ BUILDING �l MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILeD�REFS Cliv ZIP PNO^E'^ <br />___�� ni�i <br />M411 <br />GENERAL LONTP�GtOB M�IL �OORE55 CILY Z�P PMONE LICENSE • <br />� MELN�NIULCONTRAGLOA M�IL�DORE55 C�n 21P P�IONE IICENSE• <br />Reliable Sheet Met�' 11447 120th ve NE Kirkland 98033 80�3 6868 REL LL7ASTLi45LF <br />� CUSSOFwoen <br />i ❑ NEW ❑ AD�ITION � ALTERATION ❑ REPA�R ❑ DEM1IOLITION ❑ 1VOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />i <br />� W�p1T10NOFWONN�COSiOFMRiERPL5PLU5LA0001 <br />� $335.00 <br />� � OESCRIBE WORN � <br />Residence <br />LEO�L OESCAi�TION Of PROPERTV ISMOWN OELOW OR R �l <br />lOT—BLOGN—.�OF <br />I � <br />I <br />' FRONT 9EiB�( <br />�USE 20NE <br />� i'fPEOFCON'. <br />I <br />SIIE OF 9LC0 <br />i <br />11103 3rd P1 S.G. <br />Y <br />S <br />I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS AP• <br />PLICAT�ON AND KNOW THE SAME TO BETRUEANDCORP.ECT. ALL <br />PROVISIONS OF LAWSAND ORD�NANCES OOVERNINOTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 7'O <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANYOTHE� STATEORLOCAILAWREGULATINGCONSTRUC IQN <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUREOFCONfRACi9� ORAUTHORIZEDAOENT OATE � <br />x � 1 � ll �2�;�iy� <br />P. <br />M <br />0 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />.�... "'_ __. _..�_.� <br />VACANT SITE <br />OYES ONO <br />GROUP NO.OFOWELLINOUNItS <br />IF9 M�%OGC.IO�D <br />PLANS GNECKE� 9� <br />BY <br />BUILDINO <br />PLUMdINO <br />MECHANICAL <br />OfHEp <br />PENr1LTY <br />TOT�L <br />F!E <br />FF.ES VRLU�TION <br />S <br />cHCCn feE.0 ...�..,,,�s.�.,[i. <br />RECEIPf NO <br />FEE <br />