Laserfiche WebLink
S <br />..�.:'.�.}. . .'_.:._/ ,.l _. . . ,. . r..'.1.. �:1.�� 1�.�........�. :.i.... ...__ .. .. . .•.yr�..• ,. J..T;OL�,9��y..: <br />�..PPLICATrON �O: ���,„, <br />��°'"" CONSTRUCTION e <br />everett PERMtT <br />TO BE COMPIETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-87A5 ❑ COMBINATION 0 BUILDING ❑ NSECHANICAL ❑ pLUM81NG ❑ SION <br />OWNEfl � M�II�DOPE53 Cltt IIP PHONE <br />�P �i��` � n � �t { <br />` 1.� If�V`�c�� .� �� � �_. .� �E'P� t� 1 �� 2('i� 'Z- � � (c> S � <br />�RGHITECTOROESIQNER MAILAD�RE55 CITV TIP PIIONE <br />OENERALCONTfl�GTOR M�IL�OOriE55 CITY IIP PHONE UCENSE• <br />MECH�HICQCONTRACfOq MAILADDPESS Cltt ZIP PIIONE UCENSE• <br />_Sa v�n t_ <br />PWM8INOCONTR�CTON MAILADOFE55 CITY ZIP pNONE UCEN:F• <br />1 <br />:LASS OF WORN �,� <br />❑ NEW ❑ ADDITION ❑ ALTERATION L7 REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOINO RELOCATION <br />�3L <br />1 <br />iYPE OF CONST. <br />��1� <br />NA, <br />x <br />�lli. `�(`G�'-o� <br />I HEREBY CERTIFV THAT I HAVE READ ANf) EXAM�NED THI3 Ap-. <br />PLICATION AND KNOW THE SAMETO BE TRUEANDCGRRECT.ALL <br />PROVI310NS OF LAWSAND ORDINANCES 60VERNINO THISTYPE <br />OF WORK WILL BE COMPLET[U WITH WHETHFfl3PECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITOOES NOT PRES�JME TU <br />GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROV!SION3 OK <br />ANY OTH ER STATE OR LOCAL LAW REGULATINO CGNSTRUCTION <br />OR THE PERFORMANC[ OF CONSTRUCTION. <br />SIONRTURE OF WNiR�CiOR OR RU7MORRED �GENT D�TE <br />X(��\) ��'. _1 (I/� -7 / `C <br />_/ �'!� vVYLI..'1. ..� iln/'lAA/A fA //Z�f�`D� <br />NO. <br />T. U. M <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />�PPLIC�TION AGG. 9Y <br />— NA - <br />LOTAqE� <br />�� . <br />DCCUPPNCYGROUP <br />k'- 3 <br />NO. OF STOPIES <br />'Z. <br />, <br />V�C�Ni SItE <br />OYES [9P0 <br />/ <br />�C IOAI <br />n/. q <br />RPPR 'ON ISSUANCE UY <br />BUILDINO <br />PLUMBINO <br />MECIIANICAL <br />OfNEfl <br />PENr1LTV <br />TOTAL <br />FEEB <br />CUN GMEGN FEE <br />F[E RECEIPi N0� <br />VALU�TIOM FEE <br />E <br />a <br />t <br />t <br />f <br />� <br />