Laserfiche WebLink
� ..�. <br />tD�Ewr9�� . •�PPLICATION FO�►_ �� <br />��TM�F CONSTRUCTIUN <br />everett PE RM IT <br />BUILDING DEPART��IENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />� <br />❑ DEMOLITION ❑ GOMBINATION BUILDING ❑ MLCHANICAL <br />O:rNER ,„_ � �/ A e7! An. � MNIL AD�RESS n ,� Cltt iiP <br />nqoatss c'� �.J.>i , • cirv -2� `J✓/ na <br />� G �s <br />fJ <br />AOD ESS � LiTV ZiP <br />,�,�'� - �n� . <br />Z ,- �� <br />FUDR[55 � � CITY ZiP <br />PLUM1IBINGCONiFAGtOR MRLLAODRE55 <br />everett <br />e <br />❑ PLUMBING ❑ SIGN <br />FHONE <br />' �c� -/��-310� <br />` PHONE <br />' �7o G -��.� - %s <br />l PHONE LICENSE a <br />PIIONE <br />NEW ❑ ADDITION ❑ ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALURTION qF�WOR�KIC,O�STO � 1ERIALS SLNBOR� <br />�� `�-l�f-�`=3� - �.¢3�!'� �D <br />LOi�C <br />BLOC� <br />PPOJEGTnDDflESS <br />WATER CLOSE7 <br />URINAL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• �i <br />PLICATIONANDK�JOWTHESAMETOBETRUEANDCOfiRECT.ALL ' <br />PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE �I <br />OFWORKWILLBECOMPI.ETEDWITHWHETHERSPECIFIEDHERE � <br />INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO '� <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� ' <br />ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION ' <br />OR THE PERFORMANCE OF CONSTHUCTION. � � <br />SIGNATURE Oi CONTRACTOR OR AUTMORIZEO AGENT DATE � <br />if /}.� // <br />X ^ � /�% i=- �Y�ir,�-+*-v ���..3�7 <br />APPLICANiS CItY BU$ NE55 L�LcNSE NO. /� =� O�i _� �. � <br />l� L <br />AIR <br />AIR <br />FIRED 0.C. UNITS—TONNAGE EA <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL ' <br />FRONL SETBACN REAR SETBRGN SIpE SETBACK PLAN CHEC NUMBER //11 PLAN GMECN F[E i <br />�.5 � � J! � �';� � � "� � �/� � FEE�• �_� RECEIPT ND�/ � I <br />USE ZONE LOT qREA �xl � C7 `� I <br />y� V CANTSITE FEES V�Ll1AT10N FEE <br />- .S� /;���� !l (J �YES ONO � ^ � <br />TYPEOFCO�ST. OCCOP/NCVGPOUP NOAFOWELLINGUNITS � ) �, <br />,L� -l� �-� 1 � <br />BUILDING S 8 � 5 I <br />SIZE OF BLqG. NO.OF STORIES KA% OCG LOAD q/� <br />/`�91?'� � � �„(�y� PLUMBING SS(�/ <br />MECHANICAL 3 <br />FIRF. SPRINKLERS REOUIRED ❑ VES O /� <br />OTHER �O �'/ <br />iCAiION ACC BY PLANS CHECNEO BY APPP FOR ISSUANCE BV <br />� � TOTAL <br />