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4PLICATION I`Gvt <e <br />CITY of CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING 0 SIGN <br />CITY 21P PHONE <br />MAIL Aooness //�1 <br />OWNER_ //. _. .,. <br />E• <br />OMEIMG CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE LICENS <br />LU <br />. WORK I ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLANSERT <br />❑ BUILDING RELOCATION a <br />Ov dJ <br />DEECMBE' K� <br />On ��,n,.i ..✓. t SAG L. <br />LOT=ewCK; <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE TOOR CNCEL THE PROVISIONS Or <br />ANY OTHEROTY STIATE ORT OIOLATE CAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. ,S�•3-�S <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X I)/" - Al (�' V <br />TOTAL FEE >•1 _. __J—�— —'— THIS PORTION TO BE COMPLETED BY BUILDING DEP1. PERSONNEL <br />ASK REAR SETBACK <br />o To <br />LOi ARIA <br />2 6/Qo S <br />TYPE or coNST. <br />�� N <br />�^-��•- <br />SIZE OF SLDO <br />N.A. <br />NO Or ¢TOMES <br />Al. A. <br />VACANT SITF. <br />UYLS /(NO <br />NO OF DWLLLING UNITS <br />C LOAD <br />N.A. <br />BY PLANS CHECKED BY I APPR. FOR ISSUANCE BY <br />JEF <br />IFEE �o Li <br />FEES VALUATION <br />BUILDING I $ <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE <br />