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fMEr�rymn APPLICATION FOR ���,�„ <br />CITYOF CONSTRUCTION � <br />everett PERMIT .� <br />TO BE COMPLF.TED IN BLACK!NK— PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 �COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />��owur� �; Mu�eooncss eirv em v��or+e <br />.p� �p,y��-,� lal l0 Go�bW, �UP.V�"� R82o3 355•q330 <br />�ny�gr�,ronoe. cHe��e�^'`a�oonEs� '�'I�l� ��i� 1V(wi� (i +:TJ�"f_1�7 <br />i� b IA v� <br />OENEMI CONi11�GiOR MAII �OOPES$ CIIY 21P PMONE UCENSE � <br />�• I �o+��r��aw '! I I 3St'i'N''�e.4. �P,v'a� W�, °IboO'3 <br />MECII�NIC�LGONTR�GTON M�ILADORE53 CIiV ZIP PNONE LICEHSE• <br />PLUMBINOCONiP�GTOP M�II��ORE55 CIiY ZIP FHONC IILENSE• <br />:L�SSOF WORK <br />❑ NEW ❑ ADDITION � <br />MW�TIO OFWORK�GOSTOFMQ[PIAI <br />� �'l��Q� at <br />1ESC�If \C/� �N�i � <br />rr� <br />G lM� <br />lEO�L DESCRIP110N Oi PP <br />ior_eioc� <br />�Nr s[ro�crc <br />/OCi � <br />IOIIE <br />sr�. <br />� <br />DRAIN <br />, <br />ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSENT ❑ BUILDING RELOCATION <br />SG�I <br />Y 8 Gltiw!'[,l� l,awrle.x <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPEC�FIED HERE• <br />IN OR NOT. 7HE GR�ONTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE FROVISIONS OF <br />ANY OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTFUCTION. <br />SIGHAT E FCONIARCTOPOfIFUI IORIZI,�y�j� DA��� <br />X ' � i� 8 2 � <br />APPLIGRNTS CIiY BUSINE55 4GEN5`c NO <br />MECHANICAL <br />NO. 7YPE OF EOUII <br />AIR COND. UNITS—H.P. EA. <br />REFRIGERATION UNITS—H.P <br />BOILERS—H.P. EA. <br />GAS FIRED AC. UNITS—TONI <br />FORCED AIR SYS7EMS—B.T.I <br />WALLHEATFRS—BL.U. M <br />TOTALFEE !� � C�..CJ I I w�n�rcc__ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REARSETBRLN SIOESEiBQAyrc PLRNCHECNNOMOER PIANCBECN�F[ <br />�j��i� �'�� f�bl T Y// ? F �� 4f Aecein� r�o <br />J�� .�� ^ %///% <br />LO1RIi[A IyACANI9IIE � FEES V�LUATION PEE <br />35 00o sF. <br />7. S <1G'RE 5 <br />OCCU�/p]NCYCPOUP <br />f''Z./ <br />NO.OF S10BIE9 <br />❑YES �NO <br />NO. OF �WELLINO UNIi9 <br />MAK OCC LOnD <br />ONACC.BY PLANSCIIECKEDBY APPR.fORI55U�NGEBV <br />s ��� �/�� � � � � <br />BUiL�ING <br />PLUMBING <br />MECN�NICAI <br />OTIIER <br />PENALiY <br />TOTAL <br />