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� � ..^ <br />everett <br />BUILDINC3 DEPARTMENT <br />259•8746 <br />. �PPLICATION FOr. <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION G BUILDING ❑ MECHANICAL ❑ PLUMBINO ❑ SIGN <br />OWNER MI11l�0URE39 CITV SIP PMONE <br />Arthur E. Peterson 912 51st P1. S.W. EWerett 98203 258-1478 <br />11RCMIfECTORDE9�ONER M�ILADDRE98 CIiY LIP �MONE <br />6ENER�LGONTR�CIOR MML�O�NEb3 ��n' =�P oHONF LICEN9E• <br />�erett Builders, Inc. 5606 E�ergreen Way Everett 98203 353-7161 EVEREB*301PH <br />MECN�NiC�L CONTMLTOq MAIL �DpNE98 CITY ZIP PNONE IICENSE • <br />PLUMlINOCONiR�CtOM MAILADORESB CiTV ZIP ���ONE 1¢tMSE• <br />Gl�6e or w�nn <br />❑ NEW ❑ ADDITION `LI ALTERAiION ❑ REPAIR ❑ DEMOLITION ❑ WOODS70VE/FHPI.INSERT ❑ BUILDING FELOCATION <br />WLy�IION Of WONN lG0lT Oi M�IERUl9 P�11! I�BOPo <br />5,728.00 <br />19 aq. <br />912 51et P1. S.W. <br />iPONTSETB�GR <br />TVPE OF GONST <br />:1i10A �CC <br />� <br />on existing residence <br />I NEFEBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCESQOVERNIN6 THIStVPE <br />OF WORK WILL BECOMPLETED WITH WHETHEq SPECIFIED HEHE• <br />IN OR NOT. THE GRANTINO OF A PERMIT DOES NOT FRESUME TO <br />GIVE AUTHORITV TO VIOLATE OR CANCEI THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW qEGIIIATINO CONSTRUCTION <br />OR THE PERFORMANCE 0�- CONSTRUCTtON. <br />SI�N�TUAE OF CONiR�CTOR OR AUTHORIZED AOENT DATE <br />!�. - .1 • <br />X <br />Everett, Wa 98203 <br />E0. <br />NO. <br />� <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />RE�RSEtB�CN <br />NO <br />SIDE SETBACIt <br />v�C�NTSrtE <br />O':�5 CNO <br />FON <br />VUN <br />BUIIDING <br />PLUMBING <br />MECNANICAI <br />OTHEH <br />PENALTY <br />TOTAL <br />" �� <br />MBER GI�NGHEGKf[r <br />FEE RECEIPiNO <br />FEES V�L4�TION F!E <br />S�r���� i <br />