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APPLICATION FIR BLCTPN. <br />The EYSFOt"^ <br />CITY OF CONSTRUCTION <br />CIT <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />❑ MECHANICAL ❑ <br />PLUMBING <br />SIGN <br />259-8745 El <br />COMBINATION ❑ <br />BUILDING <br />ONN[R <br />MAIL ADDRESS <br />Cltt <br />c <br />ev�L v r <br />` ZIP' l <br />t 4 a I <br />^, I b le <br />{ .( /� C 1G('F: C f <br />�c�•_ v� nY'�1, ,F- <br />ZIP <br />PHONE <br />MGTIH,ECt OROCSIGNCR <br />MAIL ADDRESS <br />._ •✓-- <br />_� <br />—�.. --�' <br />1 <br />�Lf.`.ES II•-`L <br />t <br />CITY <br />21P <br />PIIONE <br />LICENS[ <br />GFNFRALCONTRFCTCB <br />LI f l li {�V�{�'� �, <br />--M <br />ZIP <br />PIIONE <br />LICCNSE • 7, <br />A•F bIANIGL LGNTRnCT00 <br />MAIL ADDRE9S <br />O LIJ) �{i^Ehl� <br />L 31 <br />�yCITY <br />N=il1 YL.Q <br />. <br />,la i•Y�,E <br />IjIIA{LiIU FUEL CO. <br />ZIP <br />PHONE <br />LICENSE• <br />MIA <br />:LASSO' wVHn <br />ALTERATION ❑ REPAIR Cl DEMOLITION <br />NEW ❑ ADDITION <br />1AL9AT NOE ,"A (COST OF MATERIALS PLUS LABOR) <br />q E C)r, <br />DESCRIBE WORM llYt (T OIJ /1Y]% �c�lOQ a;r <br />r"&Tl Toes/ j/=A r I'{ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE 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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Or CONTRACTOR OR AUTHORIZED AGENT DATE <br />USE OF BWLVnm <br />or- OCes <br />LOT __ BLOC K <br />-3-040, LL71VI VC' <br />❑ WOODSTOVE/FRPLANSERT ❑ 9UILDING RLLOCATION <br />7 YT, tk-; [JC-;I Ts /A,-1ti rlwl;�S <br />T <br />TRAY <br />NO <br />EA. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />ONE LOTAREA VACANT SITE FEES <br />6 ? l,A- OYES MO <br />OF CONST OCCUPANCY GROUP NO, OF 0WELLINO UNITS <br />5- {1 BUILDING <br />OF FLOG NO OF STORIES MAX OCC LOAD <br />PLUMBING <br />MECHANICAL <br />E SPRINKLFPS REQUIRED DYES NO OTHER <br />PENALTY <br />LI N/�CC BY PUNS CHECKED BY APPR.fORISBUANCE DY TOTAL <br />FEE J7 RECEIPT NO <br />VALUATION TEE <br />z <br />0 <br />r <br />F+m <br />