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In� EvoyrMn <br />cin or , <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />..PPI.IC�TION FO►. <br />coNsrRvc�ioN <br />PERfNIT <br />TO 8E COMPLETED IN INK- PLEASE PRINT <br />evcrrtl <br />� <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILD�NG ❑ MECHANI(:AL � PLUMBING ❑ SIGN <br />OWNER ���ILAUDRE55 CItY ZIP {'110NE <br />s�r�n��y �c��- � v�� ,�,��i,.� �� «�r� rr- y�.2 � 3 �s 7�- y� �y <br />nncNnecr noesmNee M�ILA�O�E55 cm ziP wwH� <br />GENEMLCONIRALIOR MAILPDOi1E55 CItY ZI� PIIONE ULENSE• <br />MECIUrnUI LONiRACiOq MML nDDfiE55 CIiY ZIP PIIONC LILErvSE • <br />Pl�"'�AINiCONIROCTOfI MeR�U0f1E55 cni Lrv ri�UNF I�CCNSE• <br />/�l/�it <i �-��S�YI�'���/0. %73c� -r�fj�G`L• ,5'/L'o%%�'4 S�/ i�`2 `� C s'G.F- 3� )� Ain�� i �� c° � <br />��.55 0� w�R6 � <br />❑ NEW I� ADDI710N ❑ AL7ERATION ❑ REPAIR ❑ DEMO! ITION ❑ WOODS70VE/FRPL.INSER7 ❑ BUIIDING RELOCATION <br />e.1L W nON O� W OAN ICG51 OF MAIERIhLS P W 5 LABORI <br />pESCnioE wonrc <br />• n 1 <br />useore DW( <br />� .S'/�L 1� <br />iec.i o[scAivt <br />LOt_ BLOI <br />cnaeer eooeess <br />� 2-U�? � <br />i <br />Of LON51 <br />>i1E OF BLOG <br />/i <br />i,�. Un. <br />I HEFEBI' CERTIFY TNAT I HHVE aEAD AND EkA1dINFD TIIIS AR <br />PLICP.TIOI+AND KNOW THE SAME TO BE TRUF ANDCORRECT. ALL <br />PRO`JISIONS OF LAWSAND ORDINANCES GC�VERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OF NOT. THE GRAN?IfJG OF A PERMIT DOES N0T PRESUME TO <br />GIVE AU71iORITY TO VIOLATE Ofi CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR iHE PERPORMANCE OF CONS7RUCTION. <br />SIGNATUREOFCONiR4CTORORAUi110RIZED/G[HL DA1E <br />G -2 q- � <br />X > > i o,i ,i . /1� <br />�d2 a3 <br />MECHANICAL <br />FEE NO. TYPE OF EO:IIPMENT <br />AIPCOND. UNIiS—H.P. EA. <br />REFRIGEHATION UNITS—H.P. EA. <br />DOILERS—HP. EA. <br />GAS FIRED AG UNITS-70NNAGE EA. <br />FORCED AIR SYSTEMS—B.i.U. M EA. <br />WALLHEATERS—B.T.U. M <br />UNIT HEATERS-01.11. M <br />SUBTO7AL 5 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REARSEf9AGN SIDESEL9ACN PL:INCHECNNUMOER PIANGIECN <br />APPlI�n110NACL OT <br />�) <br />��� , <br />L'UZ�1f-Y[�]i11�.Y <br />FLRNS <br />WCANT SIIE <br />OVES ONO <br />❑P NOAFOWEL <br />MRX OCQ LO <br />❑ NO <br />Bv nvaq. FOR 15 <br />fEE �ECEiPIND <br />(EES VRLUAiION FEE <br />BUILOING S <br />PLUMBING <br />MECMANICAL <br />O7MER <br />t'ENALTY <br />TOTAL I <br />