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r <br />L <br />� ��'APPLICATION FI,R <br />`�.E"ro�"� C O N ST R U CT 1 O N e°e`e" <br />��r. o. <br />everett PEFtMIT e <br />1'O BE COMPLETED IN B�ACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBINATION �. BUILDING ❑ MECHANICAL ❑ PLUMB{NG ❑ SIGN <br />OWNFR MMIApORF55 'V I�p FI�ON! <br />�`' �'.�1u't N��li� �.SL�;.?O Od jLt�M Q� .�/� El��,' � IT y.i.�0 ��: -7' ,�O/.� <br />�RCNItE OALESiGNEF M�IL� RESS v I�V 1'�a)NF <br />I <br />G(NCR�LGONiP1�iOp MML /^DRE53 �v 1iP PqONI ll[�q F. • <br />/.. _ _ . .. _. �. /� . . _ r- " _ _._ .C•ii�7M�-PY7 <br />u <br />MCGNIINIGILLGVNIfl�GIOH MAL�UpRE55 GI�V IIP PIIpNf. ���CMSE• <br />�WMPiNOCONfP�LtOA M11L�ODFE55 Cirv 2iP P��ONE LiClNSC• <br />C1A550� WOPN <br />� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ �EMOUTION ❑ WOODS10V6FRPLJNSERi ❑ OUILDING RELOCATION <br />�'!1 /. O <br />��ise o� ewio�Nc <br />cc <br />�'�ORCI eO���E55 <br />_ a v a v��� �r <br />M1FE /O�f �ONSI <br />i-�1.1 <br />iitE OF OLDG <br />RAI <br />I HERE�Y CERTIFV iHAT I HAVF READ AND EXAMINED THIS AP• <br />PLICATIONANDKNOW iHESAMG108EiRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING Th11S TYPE <br />OF WORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING Of A PERMITDOES NOT PRESUMETO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANVOTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION <br />OR THE PI::'iFORMANCE OF CONSIRUCTION. <br />siurvarm�corcor�mncroaoianun�nu�tt.nncrm nnrc <br />c�i�/'.(�1_. �/4�![J�C.L. // <br />iY\1'1�111�SIt!!5'i11Cf11S[1!(1 Y ~ <br />'i � / �i � <br />NICAL <br />AIR CON�. UNIiS-H P. EA. <br />R[FRIGERATION UNITS-IIP EA. <br />BOILER$-HP EA --_"---�-'- --- <br />GAS PIRE:D�A C UNIiS-TONNAG[ EA <br />FORCED AIR SYSTEMS-� t.0 M EA <br />__"___'___'______'_'_'-" _. __-_" <br />WALL NEAiERS-B.f U. M <br />UNIi N[ATCRS-B.I.u�--M'----�-'�� �' -'�� �'"� <br />RnNGE4100D _ ____ __ <br />AIR IIANULING UNIi- C F M. <br />__"___' _' _'"'___ _-_-'___'_.'_" "'___' <br />SiOVE <br />h11iiALFIREPLACEAC111M1iNEV_"-'—_-"- _'-"— <br />WOODSIOVE/fIRFPLACEINSEHi <br />FEE <br />5118 TOTAL SUB TOTAL � S � <br />"-'___'__' __'_-. _'_. . _._ <br />PERMIT S PERMIT S <br />_ _____-'_' ___' "__.._"_ _ '.- <br />TOTALFEE f TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REARSEiB�GK Si�E5Ei0RCM PUNCMECn U�+OE�t �'1>NCnICK�i[ <br />�`t�i3��13 �F����3 ��������r�^ <br />�IOT�RE�— VAC�NT IIE - --� — <br />UVBS �i0 FEES V11W��ION FEE <br />.� <br />ORIES <br />Zi <br />J �-� <br />NO OF pWEllINO UNrtS <br />M1% OCC LO�O <br />�� <br />AFPR ipR155U�N <br />�� <br />�UILDINO <br />PLUMOING <br />MECMr1NIGpl <br />07HER <br />f'ENAl1V <br />TOTpI <br />S �lpt(..\� <br />� <br />� <br />