Laserfiche WebLink
,�.Ewro�.� • •rPLICATI�N FO►_ <br />��^�F CONSTRUCTION <br />everett PE RM IT <br />BUIIDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION � ❑ BUILDINR ❑ MECHANICAL <br />[,wueP . M��L�OORE39 CITY iIP <br />- 5� �u-v s i ,� <br />M11L <br />Cl PLUM8ING ❑ SIGN <br />PHUNE <br />; pb'�o3 �353 36.� <br />P�10NC <br />OFI�EN�LCONiR�C10R M�ILAOOFE59 CITY ZIP PNONE LIClNS[. <br />M(C{I�IUlCO�� MAIL�D�NE55 CIIY ZIP PNONE LiCENSE.• <br />VLUMF�NOGONtR�CTOR M�ILADDRE59 Cltt ZIP PIIONE UCENS[• <br />:1 ASS O� WOI�R <br />❑ NE1V ❑ ADOITION ❑ ALTERATION REPAIR ❑ DEMOIITION ❑ 1VOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />��w�iroeorwonKitostovm•�� .isrws�.eaom <br />���0. °O %8. h T,���qGS — /60,`'����� <br />;� <br />r�,E 9F Rt Pb AcE <br />� RES/DF'N��E <br />Co�y/�os�TioN 5/�i.�/�LF'rs a�v lT���/� <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS AP- <br />PL�CATION AND KNOW THE SAMETO BETRUEANDCORREC'f. ALL <br />JRCOPIE91 �r pqpV1310NSOFLAWSANDORDINANCES00VEFNIN6THISTVPE <br />FfiTS sLy OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE <br />IN OR NOT. THE aRANTINO OF A PERMIT DOE3 NOT PRESUME TO <br />� / GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />/� � /d N ANVOTHERSTATEORLOCALIAWRE6ULATIN6CONSTFUCTION <br />OR THE PEFFORMANCE OF CONSTRUCTION. <br />� ?._a 3 SIQNATUREOFCnNTRRCTOROR�UTHORIZED�OENi DATE <br />X� ���!/.1�� ,�-� �-�s�� <br />sz8- s��� sT,�c <br />W�tER <br />Oi CONST <br />AIR <br />FOUNTAIN <br />M <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />RE�RSEtORCK SIOESEi&1CK PUNCMECNNUMBER VL�NC��EGNf[F. <br />LOi PqU <br />OCCUP/NCYGPOUP <br />VAC�NT SItE <br />DYES ONO <br />NO.OF OWEL <br />M�X.00G.LOAD <br />HY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOT11L <br />FEES <br />FEE_ RECEIPI NO <br />V11LU�TIOM FEE <br />S <br />� <br />