Laserfiche WebLink
APPLICA�► ION FOR ��e <br />�n`�"'°'"" CONSTR�ICTION 0 <br />everett PERM�T <br />TO BE COMPLETED IN BLACK INK— PLFASE ?RINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OwNER . . MAIL���RE55 CITY .. ' na,. minnc �,.� ..'. <br />MAII. AUOR[55 ��TY <br />GCNCPMCONIP�CLOR M�ilA00RE55 Cltt 21P ������f IiGENSE• <br />SQ �r�� <br />MECIUNIC�LCONiP�CTOq MAILAODNE55 QTY ZIP ��IONC LILENSC• <br />PLUMBINGCONTP�CiOF MAIL�DORE55 Cltt ZIP PIUu�I. IiCCNSC• <br />�01 WONN <br />NEyy ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA7ION <br />or <br />S�F <br />S•�.. <br />ior�eiocK—or <br />I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO HE TRUEAND COfiRECT. ALL <br />SHOWNBEIOWON�TT�CNFOUHCOPIES� PROVISIONSOFLAN/SAPlDORDINANCESGOVERNINGTHISTYPE <br />(-�.qt � u `�C OFWORKWILLBFCOMPLETEDWITfi!VHETHERSPECIFIEOHERE- <br />� I INORNOT.THEGRANT'N�OFAPERMITDOESNOTPFE-SUMETO <br />GIVE AUTHORITY TO `�OLATE OR CANGEL THE PROVISIONS OF <br />ANY OTHER STATE Jfi _OCAL LAW RFGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF GONSTRUGTION. <br />SIGNFTUREOFCONiRAC70RONAU7HORILGUnGLNf .�ATE <br />�/J9q.- �j� <br />%( ., /7 "/�/- �y� /.��z%. <br />/D5�/ 7 - �T'`� ,Dr� �e SE. <br />usc ze70 <br />tYP[ Of CONSL <br />�L-�l <br />SIZE OF BI�G <br />r-� <br />T <br />FAN <br />F <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PL�N GIIECN NUAIBER P� �N Grtf.n fEt <br />nFAR SETOACR �IOE 5[TOALN � <br />�� � <br />�p�� VAGANi SITE <br />33o sF � ��o <br />.UPANCYGROl1P NO.OF�EI <br />R-3 -M•► <br />OF SLOFiES MA%AGG l< <br />i � <br />�� <br />euaoiNc <br />PLUMBING <br />MECHFNICAL <br />OTHER <br />PENRITY <br />TOTAL <br />�� <br />�E� S REOIPI NO <br />� � � �� l f1�� � <br />FEES WW�TiOH FEE <br />4-- <br />� <br />G3�C)(. <br />