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'�-- APPLICATION Fl�'R <br />'".E"'°,"" CONSTRUCTiON <br />Gr oc <br />everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK - PLEASE PRINT <br />259•8745 <br />....�..... ���.,.� n rnnewlNATiON ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBIN(i <br />❑ SIGN <br />�ENERIILCONTR�CIOR M�IL�D�RESS Cltt EiP FNONE �ICENSE� <br />MECH�NIC4CONTR�QOH M�II�DORE55 C�TY ZIP PHONE LICENSE� <br />VLUMBINOCONIR�LTOR M�R�ODPE55 ' Cltt ZIP P��ONE 4CENSE• <br />�"NEWV ❑ A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION <br />.... �..�.... nr wnov �mGt Of MPtC RIALS PLUS LpBORI <br />,� �O <br />pESCRIBE WORIt <br />LOT_ <br />VPOJECT <br />f�FYi <br />OF CONSi. <br />ov <br />JT <br />WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETRUEANDCORRECT. ALl <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Uf <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATURE OF CONTRACTOR OR AUTHOF�ZED RGENT DATE <br />a�a svsreMs—e.r.u. M <br />FTEHS—B.T.U. M <br />17EFS—B.T.U. M <br />1TIVE COOLERS <br />iDRYERS <br />fION FAN <br />IOOD <br />v wr. uuii— GF.M. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PERNSEIBRCK S�UESET84CN <br />PIpN GNECK NUMBER PLRN CMECN FEE <br />� F[E IRECEIPiNO. <br />Of SiOR1E5 <br />VRG�NT SITE <br />❑YES ONO <br />NO. OF OWELLINO IINITS <br />BUILUING <br />M�%.00G LOpD <br />PLUTABING <br />MECNANICAL <br />-- OTHER <br />PENALTY <br />pPPR. FOR ISSU�NCE BY <br />TOT�L <br />FEES V�LII�TION I FE[ <br />f <br />LW <br />