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r <br />L� <br />�n�E.+rymn `:=+PPLICATION FC):: P��fe„ <br />°�TM°F CONSTRUCTION <br />everett PERMIT e <br />1 O BE COMPIETED IN BLACK INK — PLEASE PRM? <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING � SIGN <br />OWNkR MAiI�DDRESS Ciiv Dn p��pry� �- <br />V„ i'ctrce�s 51�.5 1o,cvoocl tih�'vc. �v 9�ao.3 <br />� <br />�.CNCR�LGON*9�C10R /� MAIL�OORESS �i1Y IiP P��pNF LiGENSE• <br />'�hevS�oYi� `o•'rrtqa.�ty 3oDt/- S.L.k ��eue�tis %t�c� !-V q��U,i �34-3�i5 � <br />MEC�UHIG ICONiR��fON M.1 �DDNE55 Grv 21P PuqNE (Iq[q5[• <br />G r?t'y Sc i8/ � f� <br />�LUMB�NOCONTR�Ctpq M��I�DORE55 CiIY ZIP PHpNt tIGENSE• <br />CLA55 OF WOpR <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPA�R ❑ �EMOLITION L–J N,�OOUSTOVE/FRPL.INSEf+f ❑ BUILDING FiEIOCATION <br />:�IU�T10N OF WONe �COSI OF MA7ERI�LS PLUS L11BOPo <br />!n c n R� <br />Q d �. 4' n�a <br />E or ew�o�r+c <br />F <br />�AONf <br />rL - I <br />fVFE Of CONSi. 1 <br />� � I"' <br />t �Fhe,.t <br />t r-1 ��; <br />�d J ,6„nod(� `7� s. 5�dc ca,• �u�r' <br />�U J- I HEREBY CERTIFY THAT I HAVF READ AND EXAMINEO THIS AP• <br />PUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />'Es pRUVISIONSOFLl�WSANDURDINANCESGOVERNING1HIiTYPE <br />�� OF WORK WILL 8[ GOMPLFTED WI1H WHETHER SP[CIFIED IiERE <br />IN OR NOT. THE GRANTING OF A PFRMIT DOES NOT PRESUME TO <br />GIVE AUTHOFITY TO VIOLATE OR CANCEL TtIE PFOVISIONS OF <br />ANY OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION <br />OR iHF. PERFORMANCE OF CONSTRUCTION. <br />SIGNALURE OF CONIRAGiOR OR AUfHORIZEO �GC1 OAI[ <br />x ✓`J-LCt, �YQ,»'l�t �^ ,ZL I-�o4 �b <br />TYPE OF EOUIPMENT <br />AIR COND UNIiS–N P. EA <br />FEfRIGERAiION UNITS–H P. F.A <br />A <br />FORCED AIR SYSTEMS–B.i U. IA EA <br />WALL H[NERS–B 1 U M11--'_–"–�–" <br />'_"__ "'___'____ '_'__"". _ _ __ <br />UNIi NEAlERS-8 T U. 61 <br />EVAPORA7NE COOLERS <br />CLOTIIES DRYERS � <br />VEN1�LAilON FAN <br />AIR HANOLING UNIi– C F M. <br />STOVE <br />WOODSTOVE/fIHEPLACE iNSF.RT ___ _ <br />6UBTOTAL SUBTOTAL S <br />__ _ PERMIT 3 "_ —PEPMIT 5 <br />._–_ "__—___— _. . <br />TOTAL PEE ! � _ _ _ TOTAL FEE_ _ __ _ S <br />THiS POHTION TO BE COMNLETED BY BUILDING DEPT. PERSONNEL <br />o'rr u� uwti � <br />�l' ,� �1' nwa <br />•nri <br />�� <br />� Y � cj'4 <br />lpi MEe <br />Il,�a 3 <br />Of:CUPe'N^GY GROUP <br />1' \ <br />I <br />Jf� <br />S�DE ^SEIB�CK <br />VI '��V <br />VAC�NI SIfE <br />❑res it�o <br />l, <br />LOAO <br />CJ <br />Aooq rRn �SS�InNCE Ur <br />�UNG� _MNUA1111N <br />�y / 383 3 <br />fEES <br />BUI�UING <br />PIU�.�OING <br />M[CNANICAL <br />OINEn <br />PENALIY <br />TOTAL <br />�ff �� ���' ��FCCICIN��� <br />VRW�TION � � / FE[ � � <br />S <br />� <br />. <br />�p <br />