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""�PPLICATION FG".2 <br />""E"'°'"" CONST�UCTION <br />cm or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO RE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAI <br />OWNEF MMl �DORE55 CITV 21P <br />G��r; "'��+ 2�5�G IG`7,-u P�..`� ��cncrr 99zc� <br />�qGHIjECTORDESi N fl MPiL�DORESS ��TY Z�P <br />�1 i�� 17ankE 4c5 �1C,T'` �;��c� ��nl�usuil�c. �tiFz7� <br />GENERRLCONTRI�CTOR M�ILAOOfi,.E/S Ci ZiP <br />�„�nrTi �l'n1rv� �x7n%7.���in���llcr Pc,iCn�i�;r:RD `urnC-n9 <br />everen <br />e <br />❑ PLUMBING ❑ SIGN <br />PMONE <br />? �7• 3f�-i' 7 <br />PNOME <br />F. 59 -�:o � 7 <br />PMONE ULENSE• <br />3;q-4S9Z <br />M[CHRNICALCONTR�GiOq MAllP0ONE55 ��^ �'r ���_�� •,"`••"•.- <br />PWMBINOCONiRACiOR MAILADDRE55 CIiV 21P PIIONE LICENSE• <br />NEWV � ADDITION ❑ ALTEPATION ❑ REPAIR ❑ OEMOLITION ❑ WOOD570VE/FRPL.INSERT ❑ BUI�DING RELOCATION <br />?IONOFyYORK�COSTOFMATERIAL5PLU5LABORI R�� <br />� �.�4-.� /n! /-Y`.�_ <� <br />COPIE51 <br />�or1 <br />I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLEI ED WITH WHETHER SPECIFIED HERC• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF �O <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS ."r <br />ANY OTHER STAi E OR LOCAL LAW REGULATING CONSTR�CTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />THIS PORTION TO BE CQMPLETED BY BUILDING DEPT. PERSONNEL <br />RGR SEIBAGN SIDC SETBAGN PLAN CHECN NOMBER PLAN CNECK FEE <br />� �� / � ��/ / �/� n� FEE a8� p5 AECEIPiNO ��&� <br />Cn lJ <br />LOf PRER yAC�Ni SIiE <br />� Co 0U sF q•Es �"� <br />OCCUPANCYGROUP NO.OFOWEL <br />R'J I <br />NO.OFSTORICS MPXOCGLC <br />� <br />UNITS <br />PVPLICAiION FCC dY PLANS CMECNEO BY APPR fOR ISSUANCI <br />r( J <br />�^ � / �' � ( � ..� <br />���\ P V <br />euaoiNc <br />PLUMBING <br />MECMANICRL <br />OTHER �� <br />PENFLTV i <br />1 <br />TOT�L <br />FEES V�LUATION <br />� <br />$ <br />FEE , <br />�� <br />