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I��EwrOrsen �.--:PPLICATION FO:� <br />����F CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION KJ BUILDlNG ❑ MECHANICAL <br />�/ <br />❑ PLUMBItvG <br />O SIGN <br />OENEfiALCONIBqG10R MFIIFO�RE55 CIIY ZIP PIIONE lICE115E�� <br />����� <br />MECIIANIGRLCONIOACiOq MAILApOfiE59 �IIY 21P PNONE �ICENSE� <br />PLUMpINOCONIMCIOR MALL�OORE39 Cltt 21P PIIONE �ICENSE• <br />ClASS Of WOBN �,� <br />❑ NEW ❑ ADOtTION I!l ALTEF7ATION ❑ REPAIF ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAlION <br />�ti�� <br />useornw�omc <br />wr�r�i�K! <br />/d <br />!� 9/ 5 FVE,�'-Er,�'t�iV !f/AY <br />8 <br />URINAL <br />FIOOR DRAIN <br />7G <br />WQ� /'"-' O <br />I HEREBY CERTIFY THAT I HAVE R[AD AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WIIL BE COMPLETED WITH VJHETHER SPECIFIED HERE• <br />IN OF NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANYOTHER STATE OFl LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. - <br />SI�NATURE OF CONTRACTOR OR AUTIIORIZE� AGENT DATE <br />x �,Q%%7 �T,.,�- 3�i%F7 <br />�PPLIC0.H CIIYItU51NE55LICEN5EN0. <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS—H.P. EA. <br />REFRIGERATION UN�TS—H.P. E0. <br />BOILERS—H.P. EA. <br />GAS FIf1ED 0.C. UNITS—TONNAGE EA <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />AEan <br />zoe�ef �Orancn <br />/ � � o"� �� J � '����) <br />PIVE OF GONSL OCCUFnNCY GRC <br />�L'11 6-2 <br />SRE Of OIOG NO OF SIORiES <br />azi� �- �a3�sr� ► <br />;AiIONACC.OY PLANSCHELNE <br />�� W <br />�o a�e' � �-� �� <br />1"'� e� Gt�l-8� <br />sme sernncK <br />�a- <br />MRIL OCG. IOAD <br />�i-y <br />L•�� <br />FEE9 <br />BUILDIN6 <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />/'P�l4N CMECN iEE <br />FEE I�I�i�_'-�+ PECEIPiNO�� <br />o[l�t�J <br />VALUBTION FEE � <br />—J sc��� P�, M�/, �z�r <br />� �uee �.��� ,2�.'a <br />Lre..,i�-j zv m Mpx.rNtu.<.� B/� <br />5l.x �v7A7�dvs - <br />