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,�1EYD1,,,,� . �PPLICATION FO._ <br />°�ry°° CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259�8745 TO BE COMPLETED IN INK- PLEASE PRIIVT <br />everetl <br />Ei <br />O DEMOLITION O COMBINATION ❑ BUiLDING ❑ MECHANICAL I3ALUMBING ❑ SIGN <br />OIVNC�I C� Mq�ADDRES$ CIiV iIP PIIO��E <br />- S r 2 J� wi rr, � 3� o� �-�b �/ f <br />eRLM�tECtORDES�GNER M�Il,1pORE55 I Clrv Z�P PnONE <br />GB![MLCONIRACION M��LA➢pRE55 Lltt ZI� V�iONE tiCblSE• <br />MfC�UNi�q[OH�MCIOB MAILA�OpE55 CIfV Z�P PI�ONE �i�p�5� � <br />FII Pnl.CO'.IP�� MqLA00FE. CIlY ZIP PnOryC 1ifU6C• <br />�6� - �lu�,b,�� �I u�Pr� e s �-Diz, t3a�l�e ll %o �2 ?J 3 i" /71 �7%�NKN �;��, <br />CU55 O� NOFN <br />❑ NEW ❑ ADOITION ❑ AL7ERATION ❑ iiEPAIF ❑ DEMOLIiION ❑ WOODS70VE/FRCL.INSER7 ❑ BUIL�ING RELOCAII�tI <br />W� W iION O� N'ORN��OSI O� IAAICRiALS PLUS UBORI <br />DESCNiBE WO�N <br />� �v � <br />vnaecr �ooaess <br />OF <br />R <br />� , X S/ C+{.�h C � HEFEBY CERTIFY THAT I NAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br />onertncnrouncories PROVISIONSOFLAWSANDORDINANGEiGOVERNINGTHISTVPE <br />OF WORK WILL BE COMPLETED WITH WHETHC-q SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERtr1T DOES NOT pRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANC[L THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGUL�TING CONSTRUCTION <br />OR THE P FORMANCE OF CONSTRUCTION. <br />SIGNATURE CONiR ipR OR pU7110R12ED nGEllt �AtE <br />X ��� a��� <br />APPLI anrscirveusv�essucviser�o <br />AIR COND. UNITS—HP EA. <br />flEFRIGERAiION UNIiS—H.F <br />�OI�ERS—MP.EA. <br />GAS FlqED AC. UNITS—TON <br />FOPCED Alfi SYSTEMS—B.i.i <br />WALL HEATERS—B.T.U. M <br />UNIi HEAlERS—B.T.U. M <br />EVAFORA.TIVE COOLEf75 <br />LLOTHESDRYEPS <br />VE�TI�qTION FAN <br />RANGEHOOD <br />AIRHqNDLINGUNIT— QF <br />STOVE <br />MG74L FIRFPI A('F R f.HlAlul <br />auuiu�n� SIIBTO7AL 5 <br />PEFMIT 5 PERMIT f <br />TOTALFEE = TGTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PERRSEIOACN SIDESEIORCN CLNNCMELKNUMpER 1'UNCnfCn�CC <br />�EE R[CEiPINO <br />LOiAP[A yqCANi51IE <br />❑Y[5 pN0 FEES V�WATION FEE <br />OCCUPnNCYGROVP NOOFOWELLINOUNIiS <br />BWLOING S <br />NOAf SIORIES MA%.00C.IOAD _ <br />A��LIC4110N�CCBY IPlPNSCHECItEDBV IAPPq(OPISSOANLEBY <br />PLUhIBING <br />MEGHANICAL <br />OiHER <br />PENALTY <br />TOTAL <br />C <br />