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�„�„�, �PLICATION FOI� <br />everett CONPERMITTION <br />BUILDING DEPARTMENT <br />255-E745 TO BE COMPLETED IN INK • PLEA6E PXINT <br />O DEMOLITION ❑ COMBINATION O BUILDINO ❑ MECMANIGIL <br />�"(�V�f�iLi� ['�OLl5ul6\ �q'OI ��'p��L �(A-(� nr <br />.uc�irm.onoeaio.�n uui.00n�as cm rn <br />R.�GIOw . �Mt�OUPi\a <br />`i l�Au`•,�tu�-%fY1 �fi40 U�(S�iuk.a�kHC n�. <br />1M1P.1ClOfl � MAIL�OORF!] <br />�.iAG�IANtUI.Q. �1104� NE. IAI S4wJ+b <br />0 <br />e <br />B�PLUMlINO O SION <br />95�09 __ �84-ii3� Sf�w�cciOiMF. <br />SIP 11qN! lIC[N}[• <br />CI NEW C!� �ODITiON ❑ �LTER�TION ❑ PEPAIP ❑ pEMOLITION ❑ WOODSTOVE/FqP�.INSERi ❑ BUILDINQ RELOGtiON <br />Z ��IDiG �li�{�$ <br />I MERFBV CERTIFV THAT I H�VE READ AND 4XAMINED TIiIS AP• <br />PLICATIONANDKNOWTHESAMETOBETRUEANOCORRfCT.ALL <br />7ROVISIONS OF L�WS AND ORCINANCES6G�VERNING THIS TYPE <br />OF WORK WILL BE COMPLETED YATH NMF'�IiER SPECIFlED HERE- <br />IN OR NOT. TME GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITV TO VIOLATE OR C�NCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW qEdllUTiNO CONSTRUCTION <br />OR TM PERFORM�NCE OF CONSTPUCTION. <br />SIONAT ( CON1R/.CIORON�piHOA D�GENI O�iE <br />x 1 i,i ti n,,n ti„� �f,_i,,. <br />�%•�- �road.r.�QM , 4.�ltn.e.t� � 012.3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />