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APPLICATION FUst <br />TAP EYFr°,..P CONSTRUCTION <br />Cl" or <br />everett PERMIT <br />BUILDING DEPARTMENt 259-8745 TO BE COMPLETED IN INK •PLEASE PRINT <br />❑ DEMOLITION IJ COMBINATION ll)"HUILDING ❑ MECHANICAL <br />MAAGADOREBB GrY T. ��L•�1 <br />elTr nR <br />OENF nAL In M, I OR <br />E= c F <br />rl <br />❑ PLUMBING U SIGN <br />PNtillf <br />35S•/�;35 <br />PIIONE <br />PHONE LICENSE <br />__xn 9 - .'3 / .SS <br />MLCNn1IC4 CONTMf.TOR win„......-�... <br />PLUMAINO fONLRACIOR MAIL ADOP!]] <br />LIN bP PITON[ IILLNSt <br />CLASS OF WOPX <br />❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br />y MOTTO, WOPx ,Low Or MATERIALS PLUS LABOPI <br />� f1�(l <br />I of ]CII woPk <br />(ro N STP Uc T 1 <br />J <br />FA <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />C. E PLICATION AND KNOW THE SAME TO BETRUE ANDCORRECT. ALL <br />I PROPERTYIMIOWN REIOW OR AiIAP,N IMIRCO1Ri ]I PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T YPE <br />_Dr gArE A-%/9Tc/>'FAA OF WORK WILLBECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. TF • GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW NO CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />i <br />91ONATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 1 l l I. p I () (L�. I <br />FCC ICE 7T <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PLAN=�APk AN CNECk FEE <br />6k RSAR BEfBALK BIDE 9EIBAC' r RE TN� -) <br />LOT I AREA � t I —I f`F1 VA^ANI SJTE Pen vALu[nox Yee <br />Gr[B r o <br />or CONSI OCCUPANCY GROUP NO OF WEI <br />U •. / 1 Iti l V <br />Of el DO NO 01 BTORIE6 MAX OCC LI <br />r 1.i cF /- <br />IION ACC BY IPLANSCHICKEDDY <br />J <br />APPR FOR ISSUANCE BY <br />G .c <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />f <br />