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� APPLICATION FG:: <br />f�� ErerO��� C O N ST R U C�' i O N <br />an or <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />❑ SIGN <br />OVINER MAIL�DDflESS dtt 21P PIIONE <br />1�oN �� Slv� l<1-..v �'0 7s:��F ��� 9s�o, 339-2z s�.3 <br />AFCN4ECTORpESiGN@R MAIUpORESS GITY 21P PNONE <br />Sq,,, c <br />GENERALWNiP�.iON MAILAODRESS Cltt ZIP PMONE LILENSE• <br />S4 .,-, E <br />MECMANICALCONTPACTOq MMLApDflE55 Lltt ZiP VNONE LICENSE• <br />`I���: .l "1Z� a-�,E �� <br />PLOMBINGGONT9�GfOF MAILApPHES$ CITY 21P iHONE LICENSE• <br />❑ NEW ❑ ADDiTION � ALTERATION � REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />WLU�TION OF YIORI( ICOSi OF IAatERI�L�S PWS UBOAI <br />� C� �� <br />, 4._� o n�, _ <br />pEs�P�IiC N'OHN � \ <br />� \ 1Y� <br />vl� C <br />IlS�EOF BULLDi �G <br />1`l- \.\ C� ti V� I <br />-F I,i .��, au\ ,.11 <br />. c���.�_�->>; P��.l <br />-� }� � 1` <br />. V'M� � � G.�w `.� ���C�1�.h <br />3� r, . O. I< �; c <br />PLUM8ING <br />NO. TYVE OF FI <br />' WATERCLOSET�TOILET) <br />� BATMTUB <br />URINAL <br />FO�IR COPiES1 <br />—7,�i G i—a_< <br />1U�1 � I Pr� <br />v�� ��� 1 <br />. .. � <br />�j ! i 3 1 i�^ S� <br />! HGiiEBY CERTIFY THAT I HAVE READ AND EKAMINED THIS AP- <br />PLICATION AtJD KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PRUV�SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WOFK WILL BE COMPLETED WITH WHETHEfi SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIO�.ATE OF CANCEL THE PROVISIONS OK <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />ON THE PERFORMANCE OF CO�STRUCT�ON. <br />SICN�TUREOFC.NTR�CTORORAU'NORIZE�AOENT U�TE <br />X �....._� � �.� �_� �l� I �''� <br />AIR <br />AC. <br />OF <br />M <br />Ti-iIS PORTION TO BE COMPLETED BY BUII_DING DEPT. PERSONNEL <br />FRONTSEfOn.N BEANSETB�GM. SiDE5ET6ACK PLANCMECRNUMBEN P, ��NCMECK <br />USE20NE <br />lO1�RLA <br />N0. OF ST081E5 <br />� � O �� <br />�� ; o <br />VACANi SITE <br />�YES pN0 <br />NO.OF OWELLINO <br />APVR. fOF ISSI/nNCE 6V <br />BUILDING <br />PLUMBING <br />MECIIANICRL <br />OTlIER <br />PEIJAI.TY <br />TOTAL <br />FEES <br />F[E .� ' - J-�� AEGEIPT �.] <br />,-,p�(o•GL_.. <br />V�LUATION FEE <br />5 <br />