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H�'PLICATIUN FOi. <br />'�� " CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDINO DEPT. <br />269-8745 ❑ COMBINATION ❑ BUIlDINO ❑ MECHANICAL ❑ PLUMBINO ❑ 91CiN <br />OWNER MAIL�DDRESS CItY 2'P PHONE <br />�,e.,�+,�,� �cc.�nF itr� -��3�'=' �r, s 1/II ctirn��T 3s3-�'��.5 _ <br />�RCNITECT OX DEBIpNEF M�II �OORE39 GIiY IIP VNCNE <br />OENEMLGONTR�CTOR M�ILAO�NESS Cltt ZIP PHONE 4CENSE• <br />N�)N'r� .i i... , r 1� l� in[ � ��.v 9�r" ELFi4f�'T �f'd u� LJ �-7 vs� a•,�1,. v lderyr <br />MECNIINIC�ICONTRACTOR M�IIADORE39 C11Y IIP PHONE 4GENSE <br />PIUMlINOCONTMCIOH M�ILIIOUNESS CITY ZIP FMONE LICFNSE• <br />r1VJucwV I�l enniTioN ❑ AL'�ERATION � REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIIDINO RELOCATION <br />USE <br />I��Ja <br />�i 51 7 -L <br />, <br />D LS- _St~�" S�T <br />I HEREBY CERT�FY THAT 1 HAV` ' � AND EXAMINED THIS AP• <br />PLICATIONANDKNOWTHESAA^�` -TRUEANDCORRECT.ALL <br />PROVISIONSOFLAWSANDOF^ ,. �OVERNIN6THISTVPE <br />OFWORKWIlLBECOMPLETED., � .KERSPECIFIEDHERE- <br />INORNOT.THEORANTINCiOFAPt�iN UE3N0?PR�SUMETO, <br />61VE AUTHORITV TO VIOLATE OR CAN�cL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />910NRTURE OF CONTRACTOR OR AUTHORIZED AQENT DATE <br />7 P, 3 <br />3' �d-YV. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />LOfnpC.A <br />GIIECNED BY <br />SIOE SETB�GN <br />V�C�NT SIiE <br />C1YE5 f1N0 <br />NO. OF O WELLINO UNITS <br />Ms%.00G IO�D <br />APPfI. FOfi ISSU�NCE BY <br />NUMBE� <br />LEE <br />FEEB <br />BtIILDINO <br />PLUMBINO <br />MECHANIGAL <br />OTHEii <br />PENAIiY <br />TOTAL <br />f <br />FECEIvI NO <br />V�LUIITION � FEE <br />