Laserfiche WebLink
ffM ErNpM� <br />�� <br />everett <br />ENT <br />'�"`PPLICATION FO`►;.� <br />CONSTRUCTION <br />PERMlT <br />B, .7 3 <br />���ron <br />e <br />BUILDING DEPARTM <br />259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />0 DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING 7 SIGN <br />� OM,NER M�IL �DOHE59 Cltt 21P PHONE <br />_ _ _' _ _ _ _ . ...—r_ . ��_� r!-�1 �1�// �� .�.��/ �'�%��% <br />I1R NI�TE�CgTOROESIONEN M�R�ODPESS Gm ur •����� <br />w L M�II�DORE55 G�1Y IIP PNONE 4CENSE• <br />OENEML GONTR�CTOR <br />n , ,co <br />V"� � ~ MAIL�DORESS GIiY 21V PHONE LICENSE • ', <br />MECH�NICAL CONiMCTOq ' <br />PLUMOINOGONTR�CTOF MAIL�DDFE59 GITY 21P PIIONE UCENSE• I <br />�� CLM90F WORN,,�,� �' I <br />�� ❑ NEW L�S ADDITIUN ❑ AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION I <br />� V�yLU�TIONOfWORN�C09TOiM�1ERUL5PLU4L�BOR1 <br />y 00 O <br />i� OEDGRIBEWORR .��`, <br />� . _i ...�.i . ..- A.�'."_. 'i'r �..;r!' .. <br />�, f� <br />LEO�L C <br />' tY- <br />r <br />) <br />7 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATIONANDKNOWTHESAMETOBETRUEANOCORRECT.ALI ', <br />FOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE � <br />OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE i <br />INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO � <br />GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OK <br />T d ANYOTHER STATE OR LOCAL lAW RE6ULATINO CONSTRUCTIO,N i <br />OR THE PERFORMANCE OF CONSTRUCTION. ,. <br />SION�TUREOFCONTqACTORORAUTHORI2EDACENT DATE I <br />X � ��.�i�%•4 ��a�� <br />APPUC�NT9 CIiV BUSMESS LiCENSE NO. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />�� <br />UBE20N� <br />TYPE OF CON9I. <br />�- N <br />812E OF BLOQ <br />�5�11� <br />FIRE SPRINKLERS F <br />APPLIC�TION �CC. BY <br />�� 6' <br />LOT�REA y���NT51 E <br />� � a � �p �S � OYES A�10 <br />R• � <br />NO. OF STORIE9 <br />CNEC1cED 9Y <br />/�..� <br />' <br />;a ioeo <br />uq <br />FORISSUAHGEBY <br />L,�. <br />BUILDING <br />PLl1MBINO <br />MELHRNICAL <br />OiHER <br />PENALTY <br />TOT�L <br />�a� <br />FE[6 <br />- .� .., .r7i..?r`\""'J.;:"".:.�1' �" T( C'.. .. <br />FEE �y J� I RECEIPT N0�/�/ �j 7� <br />- �� �� «,.� <br />V�L1111TION FE[ � _ <br />: <br />.__. � -.- .,_.._.:• .. <br />