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tir'PLICATION FO�.- <br />`"'E�'ro""° CONSTRUCTION <br />��n oF <br />everett PERM17 <br />70 BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 ❑ COMBiNATION ❑ BUILDING ❑ MECHANICAL G PLUMBING ❑ SIGN <br />OWNEN MRILAppR[55 CITY Z�P 1'110NE <br />% d Scf,.�t.G/�e.z ��'�7 _/. :�..c,b•�. s?91u�y-wtl� cvv 9rs.Z7a C S9 -�%OG9 <br />�RLNIIECiORDES:GNER M�ILADDRESS CIiV ZIP PNOYE <br />GEN[RA��pN1PAQOR MAILADORE55 CIiY ZiP PNONE IICFNSE• <br />T �U�,d � � E.. � �^ r�</ ? <^� SUv � � `a�l��� <br />�_ CUSTn, 7//.v�i 7is S. E�o�7T Eue.cd-.. ,. S y�,2,y o f� <br />MECIUNiULCONiRACTOq 1AAILApORE55�G��-/� L(/Ry CiIY 21P PUONE I�CENS[• <br />FWMBINOCONiRAC10R MML�ODfVE55 CIIY 21P PIIONE LICENSE� <br />❑ NEW ❑ ADDRION ❑ ALiERATION ❑ REPAIR � �EMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIL�ING t7ELOCAiION <br />G WAiION OF WORN�COSI Of IJ�1iEqIRiS PlUS L�BOR� <br />� <br />�%-.--� CC,n.'��T� <br />>naecr �ounEss <br />y�d2 C O—t <br />PLUMOING <br />NO. TYPE OF FIXiUflE <br />WATER CLOSEI (TOILEn <br />BATHTUB <br />LAVATOFY�WASH BASRI� <br />SHOWER <br />NITCHEN SINKB DISP. <br />DI3HWASfiER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />WAiER HEATER <br />URINAL <br />DRINKING FOUNTAIN <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />FLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />ouncoaies� PROVISIOPJSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />ou�Z OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br />IN OR NOT. THE GF±ANTING OF A PERMII DOES NOT PRESUME TO <br />GiVE AUTHORITY TO VIOLATF OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW pEGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSiRUCTION. <br />SIGNAiUPE OF CONiRFCiOR OR AUiNOR12E0 AGENi OAtE <br />X ,l� _ _ .�i'i'- <br />REFRIGERATION UNITS—H.P. EA. <br />BOILERS—HP, EA <br />GA� FIRED A.C. UNITS—TO�NAGE E0. <br />FORCED AIR SYSTEMS—B.1.U. M EA. <br />WALL HEATERS—B.T.LL Id <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVECOOLERS <br />CLOiHESDRVERS <br />VENTILATION FAN <br />RANGENOOD <br />THIS PORTION TC' BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SEipRCN <br />�Fo�iC�iiOH ACC. UY <br />VACANi SIiE <br />❑YES ONO <br />BUILDING <br />PLUMBING <br />MECNRNICAL <br />O7HER <br />PENALTY <br />TOTAI <br />fEE <br />FEES VALU4TION <br />S <br />n�aN cuEcn rec <br />I �ECEiPt NO <br />FEE <br />