Laserfiche WebLink
IM Ewr/rw� <br />pn a <br />everett <br />BUILDING DEPARTMENT <br />259•8745 <br />❑ DEMOLITION <br />..PPLICATION FOK <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />ZIP <br />eYlftM <br />e <br />O PLUMBING ❑ SI(iN <br />vHONE <br />' � �/:� - C7J/ C' <br />6ENER�LGONINAGTOR MMUDDRE55 CiTV 21P M�ONE LICENSE• <br />�/•. _S /�iJ.t�S'.%L"illiJ%li% - :Jln <' . �/.uv/%i L�' .. S'i)n..G�nf. S d il�L' !�! *l..l _ � : G_.L �- C. <br />_._.._...__.__...�_�..,.. __..__���„ ���. ��� P�°�E ; �Y`�'t�'ryrk <br />VWMOiNl7CONTRIGTOR MMIADDRE55 CITY 21P P��ON[ �i�ENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />use oo amioiNa <br />_ %�/9C! .3�s <br />PROJECT�DDRE3S <br />REPAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING FELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLEiED WITH WHETHEH SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATURE OF CONTRACiOR OR AUTHORIZEO AGENT DATE <br />flTSLItY6U51NE/55�LICF��)$ENO <br />� V • / V <br />INIC�L <br />TYPE OF EOUI <br />AIH C04D. UNITS—H.P. EA. <br />REFRICaERAT10N UNITS-H.P <br />BOILERS—H.P. EA. <br />GAS FIRED AC. UNITS—TONI <br />FORCED Alq SVSTEM3—B.T.I <br />WALL HEATEHS-9.T.11. M <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SF.IB�CK PEAASEiB�CR S�OESETB�CN PUNGNECNNUMBER PLANC��ECn <br />VSE 20N�E/ <br />� V -�. <br />TYf`E OF �ONSi. <br />��� <br />512E O� BlUO <br />�� • <br />OCCUARNCYGROUP <br />R-� <br />N0. OF SIOA�E3 <br />N.a, <br />J� <br />V�CANi SI1E <br />OYES �NO <br />NO.OF OWEI <br />MAN. OGC. <br />N <br />'R FOR ISSU�NCE BV <br />L•G <br />I �y,�� <br />FEER <br />BUILDINO <br />PLUMBING <br />MECl/ANICAL <br />OTHER <br />PENRLTY <br />TOTIIL <br />°\ J /� <br />V�LU�iION <br />S <br />I <br />i <br />J <br />