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��PPLICATION FO.. <br />�MEnryrwn CONSTRUCTION <br />�,n� <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING C� SIGN <br />OWNER MAll�00RE33 CIIY 21P PIIONE <br />��dtiii) %'l:/f..����:��i�' �%3U� �G'Cic%fti t-�%.q'�' 2S���ti�:'�'� <br />� <br />�RG�IIECIOROE516HER MAIL�OORE39 GITY IIP RIONE <br />rl�/1d"lv�Lrl� •�.6�ti Gc�✓-� SC%i-f//(' t..-�, t:i�..�'1 '��--c�?O�) <br />GCNER�LCONIR�CiOR MMI�DDRES9 CIfV ZIP 1'110NE LIG[NSE• <br />iL��i�d�•Al 5�C�Ai C'(�l� /2 S S i�E_SPLAKFif�•N• Sri�H/f `717�7 .'.S':'-�.z'o NA� b�;��6 <br />�CONIR�CiOF M�IL�ODRE93 ' Ciiv ZIP �'nOrvt UG[NSE• � <br />-�a�!//iVl� . �� i�dl)Ux,�. <br />- A%PI.�f,Al :>.dN :u r. 12.SS Cr�51 �N�<k.'.al. SFnHk' 9'6Y�^} .•B�T�c;.t..1 .. <br />�IUMBIN6CON1R�C10R MAIL�DOPE55 CITY 21P PNONE LICCNSE� <br />cUsS or wonK �{ <br />� NEW ❑ ADDITION lq ALTERATION ❑ REPAIR ❑ �EMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />y�LU�TION Of WORN�COSI OF M�IE�I�LS PWS L�BOIp <br />/ <br />I.SCti� �+U <br />ocscn�eE woarc yYo�1o• <br />��i�ll�r �d /1 �n% •> ' 1 �i G� loM ?�/F /9Ni7 .J��S�i��i/ .Vc �.J ', b.�•'r) <br />usi or eunon+o I HEREBY CERjIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />U/� �./: �'' a/ L D• PLICATIONANUKNOWTHESAMETOBETHUEANDCORREGT.ALL <br />IEU�iUESCniPTiONOfPRO�E��YISNOWNBELOWORATT�CNFOIIRCOPIE51 pqOVISIONSOFLAWSANDORDINANCESGOVFFNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITI� WHETHER SPECIFIED NERE• <br />iot_e�ot�or� IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO ViOLATE OR CANCEL THE PFOVIS�ONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIO�� <br />— OR THE�FORMANCE OF CONST t�CTION. <br />SIGNATUR O CONTPR�OpORAOfHOA 'DAGEN7 OA1E <br />/ / / <br />�� 3G� c <br />rno�cc*�oon[ss <br />� <br />�PFLIG�NTS dTY <br />EA. <br />MEATEHS-0. <br />TRAV <br />DRAIN <br />M <br />�C�/'ri`� <br />S �—__'_ <br />THIS PORTION TO BE COIvIPLETED BY BUIL.DING DEPT. PERSONNEL <br />nLa1�5Ei0�CK SIOESEI9�GK �LANCl1EGNNUMBER PtAlICI1CCN <br />.OIAqL� <br />OCCUP�NCVGPOUP <br />NU OF S10RiE5 <br />7E0 ❑ YCS ❑ <br />1'L/.NS GIIECKED 9Y <br />WC�NT SiIE <br />UYES CVO <br />fOR <br />f[E �FCCIPf NO <br />FEES ��tUAf10N fEE <br />5 <br />OUIl01NG 5 <br />PLUMBING <br />MECMRNICRL <br />OiHER <br />PENALTY <br />IY — <br />C T0TI1L <br />� • � ' <br />