Laserfiche WebLink
Ins Ererprron <br />�iTM oF <br />everet� <br />BUILDING DEPi. <br />259•8745 <br />OWNE� <br />! �/ / 1 // 17 <br />r.PPl.ICATION FO� <br />CONSTRlJCTION <br />PERMIT <br />70 BE COMPLETED IN BLACK INK— PLEASE'?RINT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />MRIL�ODNE55 CIIY ZIP PNONE <br />i�, <br />everen <br />� <br />❑ SIGN <br />OENEN�ICONIMCIOR MAILhppRE55 CIiY ZIP PNONE 4CENSE• <br />i r A / . . �, i i _ �. _ �, .� � _ _ "' <br />21P PNONE <br />FLUMBINOCONtRACtOR MAILAD�PESS CIIY ZIP PMONE LIGENSE• <br />_'.'__ _. .._.... <br />❑ NEW ❑ ADDITION ❑ ALTERATION �REPA�R ❑ DEMOIITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAIUAiIOM OF WORH �COST OF MRIERIALS PW S U90R1 <br />� � <br />�T'7R/� � n /�i.,.,,.�c-✓ ,>'�fcK �,.�r ,Pi�n� S ��T�GR.. �7l,nn,o.r � !�%ini.Tn�v� <br />n <br />TI ��P.INAL <br />�� I RINKING <br />FRONISEIBACK <br />USEZONE <br />ttPE OF CONST. <br />5¢EOFOL7�. <br />�r N <br />WASHEP <br />B <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />FOIIRCOPIESj PROVISIONSOFLAWSANDORDINANCESGOVER�JINGTHISTYPE <br />� �� � 'L�' OFWORKWILLBECOMPLETEDWITHWHETHEFSPEC!FIEDHERE- <br />IN OR NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANY OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION <br />OR THE PEfiFORMANCE OF CONSTRUCT�ON. <br />SIGNATUPE OF CONTRACTOR OR AUTHORIZED AGENT Dn7E <br />X Y. A.,���� / _A_�t/ <br />AIR <br />AIR <br />LICENSE NO. <br />PERMIT S PEHMIT 5 <br />iOiALFEE S TOTALFEE S __ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REARSEIBFCN SI�ESET6RCK PLANCHECKNUMBEN P�/NCMECNFEE <br />�PPLICAlION RCC.'3Y <br />VAC0.NT SIiE <br />❑YE9 ONO <br />GROpP NO.OFOWELLINOUNIi3 <br />IES M�%OCGLOaD <br />S ❑ NO <br />NEO BV APPR FOR ISSU�NCE BY <br />FEE9 <br />euaoiNa <br />PLUM9ING <br />MECHANICAL <br />OTMER <br />PENALIY <br />TOTAL <br />iEE RELEIPT N0. <br />VALUATION FEE <br />s57.S(�rO S� 50 <br />5(� Is�i <br />