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{ �'APPLICATION F "':i <br />��.Ew,,,..,� CONSTRUCTION <br />cm oa <br />everett PERMIT <br />TO BE COMPLE?ED IN BLACK INK — PLEASE PRINT <br />BUIIDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING C MECHANICAL <br />r , <br />❑ PLUMBING ❑ SIGN <br />j GENERALCONiRACtOp MAIIADDHE55 Gltv LiP PIIONF �IGENSE♦ <br />" Ma�w�.'s �,..rc ISiS 16fu.� St l3sic� �Fc ��x �,�� ��o <br />MECH�NICAICONTMGTON MMLADDRESS CItY ZIP PHONE � �ICENSE• <br />PLUMBiNOGONTMCTOR MML�DORES9 CRY IIP PHONE IICENSE• <br />I� NEW ❑ ADOITION ❑ ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />WLW❑ O�WORNiCOS^TOFM�TENUL5PLU3LA80iry <br />� � � / � <br />�o*_ <br />� <br />I MiEREBY CERiIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORqECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETEG WITH WHETHER SPECIF�ED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOi PRESUME TO <br />GIVE AUTHORITY TO VIOLAiE OR CANCEL THE PROVISIONS OF <br />Ayy11IHFASTATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Of CONTqACTOR OR AU�GR1[� AGEN7 DAiE <br />TYPE OF EOUIPMENT <br />AIR COND UNITS—HP. EA. <br />REFRIGERAIION UNITS—H.P. EA. <br />BOIlERS—H P EA. '_"--'—'�'- <br />GAS FIRED AC. UNITS—TONNAGE EA <br />M <br />INSERT <br />���'�'^� SUBTOTAL f <br />PERMIT S _ ----PEPMIT —'---�—... S <br />TOTAL FEE t ______ TOTAL FEE___, _ 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />5¢FOfB/ l� <br />FIRE SPRINKLER <br />L �VP�Ipq10N�CL pY <br />�� <br />REAX SETB�CI( SIDE SEtBAGK <br />LOT�RE� V�LMRS�TE <br />fiVES ONO <br />OG � GROUP NOAFpWELIiNGUNIIS <br />/ i / <br />NO.OF STORIF.9 _ M�% OCC LOAp <br />' -..�\ <br />iED ❑ YES ❑ NO � <br />PLANSCNEGNE00Y RVPRfORI55U�NCEBY <br />��� � � <br />CHECKNUMBEH <br />fEl. <br />FEES <br />[1UI�DING <br />PLUMDING <br />MECNnNICAI <br />OTMER <br />VEARLIY— <br />T0T1L <br />3 <br />PI.�N CHECN fEE <br />�ECEIP! NO <br />V�LU�iION fEE <br />� <br />� <br />�� <br />