Laserfiche WebLink
. � <br />HPPLICATION FO1. � <br />`".`'"`°'"" CONSTRUCTION <br />cin or <br />everett PERMIT <br />BUILD��JG DEPARTMEN7 TO BE COMPLETED IN INK- PLEASE PRINT <br />259•8745 <br />❑ DEMOLITION ❑ COMBINATION 6jBUILDINCa O MECHANICAL <br />ZIP <br />❑ PLUMBING ❑ SIGN <br />!1 PHONE <br />V �53 �3y/ <br />Po�ONC <br />ounuv iICENSE � <br />.� ] � Lltt 21P PNONE UGENSE • <br />MFC1UNiGL GONTPALTOfl MML �DOPESS <br />PWMBINaCONTR�GTJN MMLAUUFESS GIIY ZIP PIIONE LICENSE� <br />i Oi WONN <br />NEW ❑ ADI]ITION ❑ ALTEFiATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTnVE/FRPL.INSERT BUILDING RELOCATION <br />iTION OF WONN � W ST OF M�T[RULS PLUS L�BOR� Q M�/� <br />�� w " /] V�1 �� V�:.J �O � <br />�/Nqc6 �L4/'�(/cY _ <br />G�L�ESCNiPPONOFPPOPENIY�SN WNBEIOWOR <br />�r�eioc�+►�= +"' <br />7i,l�fcT 13 R.�,�e< / <br />%r5 �ER /'Lrf% /�F�v� <br />�l✓ c.c /'<.f?^ �'�JFi� <br />f10�E�tl/�DOHE55 %4Z� ' <br />/%f"�ri�r►J S"���� ~ � 40/7 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <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 />SIONATURE OF CONTPACTOR OR AUTIIORI2ED AGENT DRTE <br />X�o.+. � .. �` /Uu✓ ,Zo �lG <br />TcflfV IIi1N[SSLICEIlSENO <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />,_.. _ Z f �. s <br />� <br />LOT �RE� VAC�NT SITE <br />!C ZS�p9 OYES ONO <br />J <br />INST OCCUPANCY NOUP NO.OFOWELI <br />"N R-3 M- l / <br />oa NO OF STOPIES M�x. occ ie <br />�_i t<�f 2 -- <br />�� � I J� � I � .� . <br />�f6 / � �l �'I �r3 <br />FEE a � q <br />recs v�w�noH <br />a���o�Na s o rurv._ _.� <br />PLUMBIN� <br />MEGMANICAL <br />OTHER <br />PEN�LTY <br />TOT�L <br />6'iGuuuees ato-� -['o �ed <br />2s t'T. Aae�rs a��rzaws <br />�L1rsVAT�onJ bT "T►t� �� <br />OM■"Lti16 FDt,.n4� <br />�•J <br />� <br />