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A.'PLICATION FOR D��u-e: <br />CITYEOF o,�n C O� N S T R iJ C T I O N � �veretl <br />everett PERMIT s� 2'Z��3z5 � <br />BUILDIN� DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ 9UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />ow,-.�.9� E�l �01,Sr/�DDP,��oS,l�o,�q,P// ��ve/If77z/�'��ol P..a„E - <br />♦RCHIIELIONOESiGNER MAI�AODNE55 CItY ZiP PnO�IE <br />�GCNERI LONiP1C� I1 MAIIAO�qE55 C11Y ZIV PH(JNE LICE!!$E• <br />.9,e ���+c= .-%M��u�'.��f�� �o �/S�� NAv .S �drr�e� i�d43 'c1A� �i � iy�e� <br />ucc�uN,cueoH�aeeron MPI_AODNESS cnr zin r�w�+e ii�E��y�. <br />VLUM6IN(iCOHIRALfOR M.�IlAp011E55 CIiV $Ip pqONE �I�pISE. <br />[�455Of WOFN � <br />❑ NEW ❑ ADDIi1ON ❑ ALTERATION EPAIF ❑ DEMOLITION C WOODSTOVE/FfiPL.INSE�iI ❑ �UI�DING RELOCA110N <br />v�Lu�rioN of Wonfl iCoSt oI Mn� W u�s PWs Lneon� <br />��� � <br />WG�N <br />( P.S /Oe, <br />LEG4 OESCAIPI IpN <br />LOit.>>ivBlOC1L <br />NO. <br />VACUUM <br />/ Y � <br />-F P �e oic�/ or� — f �Ain�'T �T��'ru/� <br />/ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TPUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCEL'.GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED W17H WHE?hiEFi SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMITDUES NOT PRESUME TO <br />GIVE AUiHORITY TO VIOLA?E OR CANCEL THE PROVISIONS OF <br />7/J�� ANYUTHERSTATEORLOCALlASYREGULA7"INGCONSTRUCTION <br />OR 7HE PEFFORMANCE OF CONSTRUC110N. <br />f- j�j SIGNA7URE OF CONiRACiOR OR AUi110RIZED AGENt DA1E <br />� �- �'�z�� `'�F� � <br />APPIICAN SGIIYBUSWESSLICENSENO . �/ , _ �, <br />TVPE OF EOUII <br />AIR COND. UNITS-N.P. EA. <br />FEFRIGEFATION UNIiS-H.F <br />DORE[.$-.H.P. EA. <br />GAS FIREO A Q UNIIS-TON1 <br />FORCFD AIR SYSI[MS-B.T.I <br />WALLHEATERS-B.T.U. M <br />UNITHEATERS-B1.U. M <br />EVAPOFATNECOOLERS <br />CL07HESDRVEPS <br />VENTILATION FAN <br />RANGEHOOD <br />AIR HANDLIIlG UNIT- QF <br />STOVE <br />ME7AL FIflEPL4CE 8 CHIMNf <br />S <br />THIS PORT�GN TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />(RONf SEtBAGR NERR SEI6ACN SIOF SEI9ACN PIAN G1ECK NUMpEO vLAN G4Cx fFE <br />�t / <br />pl(�� oc J� �� f$y� FEE � � f1ECE�PiNOQ <br />USE20rvE �OI�BEA �/ )� —_ L <br />— � �L}+A'f) �f� ❑ ES,�pRO FEES �RlU4TI0N fEE <br />V V —�--{ <br />IVFEOF�ONSi OCCUP�NCYGPOUP NO.OFOWE}�INGUNItS I <br />- ,r . , i% . � / <br />V u \ 1� <br />� <br />/ � <br />MAX OCC LO>U <br />F0915SU�NCEBY <br />�/, �' . <br />9UILDING I S <br />PLUMOING <br />MECH�NICAL <br />OT11ER <br />PENALTY <br />TOTAL <br />