Laserfiche WebLink
t�r.PPLICATION f0`�.�� <br />fMEwryn�n CONSTRUCTION <br />pn or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION <br />�NER <br />/uPC/ a� �i�'�; <br />❑ COMBINATION � BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />M�II�ODPE55 CIIY ZIP PHONE <br />a�� .��o�Z.Si.,:,,�,:/- �l:ra�.t� i:l�o/ •?$=1S?� <br />❑ SIGN <br />OENEMLCOHTR�GTOR M�IL�OORE55 Clrv Z�P PHONE UGENSE• <br />MECM�H�C�LCON1R�CfOB MMI�DOPE55 Clrv IIP PMONE UCENSE• <br />%UMlINOCONiR�C!011 MMI�DDRE55 Cltt 31P FnONE I�CErvSE• <br />GL11SS ll� wUNR � <br />❑ NEW ❑ ADDI710N ❑ ALiERATION �❑�REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V�LU�TION OF VIORN �CO�1 OF M�iERI�L9 GLUS UBORI <br />� �� � <br />OESCRIBE WORN / <br />"Ct�/'� [.l. t �.' -: � � / '� .2 iG <br />��t[c.1 C <br />�or�e�oc S�S or_ <br />�.�:1.��, L u ,�_, c <br />.4 � ��1 ��/• <br />�r-< . <br />;/.'.�4�- �.�5 -(�/7_ Gnu'% <br />',T�DORE99(� ' / <br />��02 JCf �1t�1f�� � `V-CY.C'� <br />I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS AP• <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWSANDORDINANCESGOVERNINGTNISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTINOOF A PERMITDOES NOT PRESUME TO <br />OIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAI LAW RE(iULATIN6 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATURE OF CONTNACTOR OR �UTNORI2E0 ROENT O�TE <br />��x��,�` �z�.L � �,-7-�=� <br />•PPLiC�NiS CiTY BU9HE55 LIGENSE NO. <br />M <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SEIBALK RERNSEIaILK SIpESETB�CN PLANGMECNNIIMOkR VUNGHECN <br />Si2E Of 6L00. <br />�PPLIC�IION AGG 6Y <br />IIQ•L <br />lNd�lllJ <br />WC�Nt SIIE <br />❑YES ONO <br />♦PPR FOf1155U�NGE BV <br />I / . � \ <br />BUILDINO <br />PL�MBING <br />MEGHANICRL <br />OTIIER <br />PENALTY <br />TOTAL <br />FEE PECEiPt NO. <br />FEES V�LU�TION FEE <br />S <br />