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� ' ; �, <br />rn. Ewryn�n <br />CITV Cr <br />everett <br />BUILDiNG DEPT. <br />259•8745 <br />�„PPLICATION FOi� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />everett <br />e <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ pLUMBING SIGN <br />y ,r� MAILr1DD/flE�'S,�5 /(�� CITY/?�, 21P p PHONE � / _ (� <br />I{�/ii/�/�I/G ' ll,i� `�/M�I'��7 ��' 7(/u /ff/("'11��H�W(/�LL% � /`OZp <br />ARCMIIELTORDESIONEfl MAILADDPh55 CITV / ZIP PHONE <br />�� <br />GENEpRLCONTHACTOR MAILADDqESS ptY ZIP PHONE '_ICENEEs <br />�`9-` oY �-9 � s'c �r� � o <br />MECHFNICFLCONTliACTOB MAILA�ORE55 CITV ZIP PMONE UCENEE• <br />� <br />s <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPI.INSERT ❑ BUILDING RELOCATION <br />TION ne wnwu irncinr..nreeier e . <br />'___. _. ......_._.__' ____....... r <br />��j L � <br />)HK , <br />12 LG� ��i — ��C' ^7/.i� S (� � ���'ii/ <br />)ING <br />IIPTION OF PpOPERTY (SHOWN BELO W ON ATTpf Y FOUR COPIES� <br />IOGK�_OF <br />( �' T LmT 1 �n <br />� <br />o./ 1 �r ( +�� Z9-_rr) <br />� i2 — z��' P� ..� h F <br />:crno��_s� �iLr (�o•� r✓r ✓L <br />%]' I ��?� //L- / J <br />��iL OCS�/Q//(14'1 flL�((� GLr ✓Qf� <br />F'y cv �/ / X fi %O/� i//.v ///4�l ir✓t: s-/y ) <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT.ALL <br />PROVISIONSOF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITFI WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OFl CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAN' REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUREOFWNTflACT RORAUT:fURIZEDAGENT OATE <br />X ��.' <br />S' -r" �'i' <br />.PPLICANiSCIiYBU51NESSLICEN5EN0 ,r/y��.- /�/N..-�f��L <br />i7o1' � <br />FORCED <br />M <br />TH{S PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK REARSETBACK ISIOESETBACN PLpNCHECKNUMBEF PLANCNECKFEE <br />'rEE IRECEIPTNO. <br />NE �OTRRER yqLANTSITE <br />pYES ONO FEES VA�UATION FEE <br />TYPE OF <br />ACC.BY <br />OCCOPANCYGROUP <br />MA%. <br />UNITS <br />BUILOING <br />PLUMBING <br />MECHANICAL <br />OTMER <br />PENALTY <br />TGTAL <br />S <br />