Laserfiche WebLink
':..PPLICATION FO'��� <br />,".E".,°."° CONSTRUCTION <br />qr �F <br />everett PCRMIT <br />BUILDING DEPARTMENT <br />2�g-87a5 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />v, � <br />ZIP <br />everen <br />� <br />❑ PLUMBING �IGN <br />PHONE <br />~� _ <br />PMONE <br />P110NE UCENSE • <br />vs?o yv�3a=/f��c31lCu5 <br />PLUMOIN�IGO����ACIOfI MAILRODO[55 CIiY ZIP PIION[ LICENS[� <br />❑ NEW ❑ ADDITION ❑ ALiERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSEF7 <br />I�LU�iION OF WOf/iN IC09I Of IAI.ICf11�L3 PLUS IRBOfl� <br />� /1.417 M <br />�or <br />IAODRE55 <br />4Y�C/ G(/[ <br />BING <br />TYPE <br />Wl.iEN CLOSET (TOII <br />BATHTUB <br />LAVATORV�WASN BP <br />SIIOWER <br />KITCHEN SINK E DISI <br />OISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />WATER fiEATER <br />URINAL <br />ORINKING FOUNTAI� <br />FLOOR DRAIN <br />U[�I2FY1 <br />�.� f7n.w..1 <br />9N#kBIMB-RELOCATION <br />' � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />�c PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />ORRITRCNiOUfICOP1E5� pROVI510NSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED VJITH WFIETHEfi SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITOOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUfiE OF AC R UTII ED A NT DATE <br />X /_�_ 7 tr��7 <br />NO. <br />AIR <br />TOTl�LfEE SI I I I TOTALFEE _ SI 1 <br />THIS �ORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />dLA115[IDAGN SIOESEiDACN PUNGHECftNUMpER FLhNC11ECN(EE <br />FEE �ECEIPT NO. <br />lOi�f1EP yqC�NT5IIE <br />OYES ONO FEES VplUl1TION FEE <br />NO Uf SL0111ES � MA%. OCG LOAD <br />Fon <br />t <br />BIIILDINCa <br />P�UMBING <br />MECN�NICAL <br />OTHER <br />PENALTY <br />TOTAL <br />E <br />/ , <br />I%Rl/�/ / 1�1 1 // � /�I <br />m <br />