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N. EYiiromR <br />CITY OF <br />everett <br />3UILDING DEPT. <br />159.8745 <br />E. WIRT <br />ING <br />APPLICATION FOR P <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK-- PLEASE PRINT <br />❑ COMBINATION ® BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PNoNE <br />AA', ADORES <br />4712 SOUTH 3rds EVERETT WA 252-6925 <br />IESS <br />SR 92 LAKE STEVENS 4 <br />98258 691-607 <br />I OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />Construct carport <br />of uuaoiNc <br />Carport <br />V OF <br />2 <br />4712 South 3rd <br />YPE <br />stg <br />Lowell Div. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IR NOT. THE GRANTING OF A N AUTHORITY TO VIOLATE ORECANCEL THE PROVISIT DOES NOT ONS UME TO <br />GIVE IONS OF <br />ANYOTHER STATE OR LOCALLAW OR THE PERFORMANCE OF CONSTRUCTION. <br />REGULATING CONSTRUCTION <br />SIGNATURE OT CONTRACTOR OR AUTHORIZED AGENT DATE <br />Q <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PLAN f,R ELS FEE <br />BY <br />14W/n <br />VACANT SITE <br />OYES ONO <br />No. OF O WELLI <br />1-3k � <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OT14ER <br />PENALTY <br />TOTAL <br />s <br />FEE <br />