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�,..PPLICATION FO.:� <br />'r.E'.'°`"" CONSTRUCTION <br />��r o. <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANtCAL <br />owueA AIML I1p00E55 p�ry � i�p <br />zir <br />�. <br />❑ PLUM4ING ❑ SIGN <br />PIIOHE <br />� <br />r�ror+c <br />� �31� � SS;.�2_ <br />FNON[ UCENSE• <br />mEcruHicucunnmciuq . rnsit�uuness CITY ZiP PIIONF LICENSE• <br />PLUMBINGGONIRACIOR M�II�pOfiES$ CIiY ZIP pIIONE IICf�lSC• <br />;1A55 OF WORa <br />❑ NEW ❑ ADb�TION ❑ q1,iLf7ATION ❑ REPAIR ❑ �[MOIITtON ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br />2 0 5. �. -�..-�.��- Mn�.t. <br />WATEN CLOSET (TOILE <br />�A1MUG <br />LAVATOHV�WASH DA51 <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDpYTRAY <br />CLOiHES WASNEfi <br />WATEP HEAiER <br />URINAL <br />OR�NK�NG FOl1NTAIN <br />I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNIN6 THIS TVpE <br />OF WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTIN(3 OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF' <br />ANY OTHER STATE OR LOCAL LAW FEGULA i INO CONSTRUCTION <br />OR THE PERFOFMANCE CF CONSTRUGTION. <br />SIGNATUREOFCONIqACiOROR�UTHORI2EDAGENT DATE <br />/ <br />X'�L!__�t_.���L ��.�5� � ,�7-� � - �''% <br />�PPIIC�N I'S GI1 Y BUS W E 55 LICENSE HO� <br />TVPE OF <br />AIR COND. UNI7S-H.P <br />REFRIGERATION UNIT; <br />DOILERS-H.P. EA. <br />GAS FIflED AC. UNITS� <br />FORCED AIR SYSTEMS <br />LY4LL NEATERS-B.T.❑ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />!IS[Ip�C6 fl[Pp$Clfl/CR SIOESEIOALK � q �.�•„ PL�NGIIECNNpAlOFR PptANL1�ECRiEE <br />/il �� f� 1 i' fl ��l�j!t Af I:'/i (''_ -/1 /1 7 > iEE (`1 �0 RECEIPiNO� %J r'4 <br />�ON[ lOf q1E� `� • " " � �.,� � � / — � � � <br />L�c� �-- � � � � ����NISIIE FEES VAWIITION FE[ <br />•� lJ J,> L I hYES ONO <br />Of CO�ISI OCCIIP�NGV GIIOUP NO OF OWEtUN6 W11i5 <br />�-x./ f3-2 ` ?Gd,6i�- !!q7 5( <br />or ni nc No or s�onies Mnx. occ. iono euaotNa i <br />?�1-7� �- / �'� PLUMBIN6 <br />/7�<� <br />LI�cG OY 1'lnN5G1ECNE00Y <br />��� ,��V� I� <br />L -c <br />�/��c%dr�6 To ,8c� u.�n��. <br />5�'cxdZ� ��+���-. <br />OY <br />MECIIANICAL <br />Jf11Ef1 <br />PENALTY <br />TOTAI <br />= c, , • , _, _ <br />_. � �• � , � <br />�� � � � � � • <br />� , <br />