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y1i � ,. <br />, . ,�,E,,,,„,� ��PLICATION FOR'�'� <br />«^� CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COI'dPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL <br />OWNER � M�il �DONESS pIIV tip <br />21P <br />[ir <br />everen <br />e <br />❑ PLUMBING ❑ SI(3N <br />PMONE <br />.�47-✓r �U <br />PNONE <br />���ONE UCENSE • <br />- .. '.. • ^"^c LiCENSE • <br />�LVMlINOCONfR.1C10R M�II �DORE45 CIfY ZIP PIIONE IICENSE • <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPl.INSERT ❑ BUILDING RELOCATION <br />i <br />rtu�iNa <br />KITCl/EN 3MiK i OISP. <br />pD//WASIIER <br />uuwonr rn�r <br />DIMNKIN3 FOUNiAIN <br />FIOOR ORAIN <br />MCIIROW PREVENT� <br />ROOF ORMN$ f�� <br />SINK 1lE� RV� <br />/ �w <br />/ KM <br />TOT� <br />OHTS[I81Cc q(�RSEI <br />EtO�q �p��p� <br />` ' � <br />>E OF pON31/ �S� p�CUP�N <br />� <br />. ore�oa eoorsi <br />. <br />� . u .. �. _ ,. <br />I <br />� O <br />I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS AP• <br />PL ICATION AND KNOW THE SAME TO BE THUE AND CORRECT. ALL <br />:eo�Es PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br />�JP OFWORKWILLBECOMPLETEDWITHWHETHEqSPECIFIEDMERE- <br />— !N OR NOT. THE GRANTING OF A PERMITDOES NOi PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OH CANCEL THE PHOVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REdULATIN6 CONSiRUCT10N <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SION�IURE �Of C�ONIR��CTOR OR AU�TN �12f�01�8��'1�/f f1�TE �/'/B8 <br />X ' / / ,.��� / / <br />� _ <br />78�J0:%� V�CANTSIIE <br />YES ONO <br />UP MOOiOWELUNO <br />� ��� <br />� �� � � � � <br />Se �wp(1 � „w�i, � �j <br />`� �INnn�l,n.�. r-. f'Vuf� "�.iMlt� <br />NO <br />MECMANICAI <br />NC - MMOI.O UPNTS - N P. <br />NEFRI�EMTION UNITS -N.P. EA. <br />BOILEHS -l.T.UM P. <br />OAS FIRED 11�C. UNITS - B T.U. <br />FORCED AIR £YSTEMS - B.T.U. M <br />WALLNEATERS-B.TU. M <br />UNIT MEI1iERS - B.T.U. Y <br />CLOT/1E5 DRrEPS <br />VENTIlAT10N FAN <br />MN6E NOOD <br />WATERHEATER <br />wOOD 5T9VE � <br />CMIMNEV <br />PLAN CFiECK NUMBER FEE a e. RECEIPT NO. <br />� /�i9r�o ai o= 4, <br />BWLDING S � <br />PIUMBING <br />MECMANICAL <br />OTHEfl <br />S7A7E BUILO�NG SURCMARGE � <br />STATEENERGYSURCNARGE I <br />PUBLIC WORKS <br />TOTAL "%i <br />PFOPERiV OWNEi7S ARE RESPONSIBLE FOfi DETERMINI�lG ALL <br />PiiOPERTV LINE LOCA710N5 AND RELATED EASEMENTS. <br />� <br />