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IM EVMpm� <br />pT�' OF <br />everett <br />BUILDING DEPARTMENT <br />259•8745 <br />a�'PLICATION FOR <br />CONSTRUCTION <br />PERM(T <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL <br />CIiY <br />�PLUMBING � SIGN <br />PMONE <br />PNONE <br />VLUM8INOGONTH�GTON M�ILADOPE55 ui� 21P PHONE IICENLC• <br />:L�SS OF wunn <br />❑ NEW �ADDI710N ❑ ALTERA710N ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPL.INSERT ❑ BUILDING RELOCAT�ON <br />""_..__ ..___ <br />�-om �:,r� <br />UBEOFpWLDIN ^ <br />i� t <br />LE �1LOE4C iiONO'PROPERiVI <br />LOTLiLBLOCK-OF ( <br />10 FyP/FI I ryCC <br />�N VOL �� A � �)�Q <br />Sh,��,,.:,� �n <br />*� <br />o �` <br />1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNRTURE OF CONiPACTOR OR Al11HORl2E� AGENT OATE <br />X � � w�..�� y� �-�� <br />1PPliCANiS CItY BUSINE55 4CENSE N0. <br />���37� <br />a. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />iRONTSETBACN PE�RSEiOACN SiOESEct�B�CN PL�NCNEC NUMBER ,n PLANC��EGNFEE <br />a V `� V `� g� � I(, I I�� f[[�� LL� RECEIPI NQ.7 /./_ cl <br />CJ�O <br />U9EZONE �OT�RE� y�C�Ni51fE FEE6 V�L1111TION FEE <br />L� ` a G� j� OYES %.SNO , r� <br />/� <br />ttPE OF CONST. <br />� <br />SRE OF BLDO. d) <br />6V <br />�PPLIC�T�ONACC BV <br />YGROUP NO.OFOWE4 <br />i�'� � <br />I� <br />UNITS <br />G G• <br />BY <br />B�IlDINO <br />PLUMBING <br />MEGH�NIC4L <br />OTHER <br />PEN�LTY <br />T0TI1L <br />S <br />�J <br />