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1M EqrpNn <br />dn u► <br />everett <br />BUILDING DEPT. <br />259•8745 <br />e. <br />� <br />h�'PLICATION FOh „�„„ <br />CONSTRUCTION e <br />PERMIT ,� <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />O�COMBINATION ❑ BUILDIN(3 ❑ MECkANICAL ❑ PLUMBING ❑ SI(iN <br />:o. <br />MUL <br />� 9Bs �s sss-�lqt <br />cin liP-- YIWN! <br />GIIV iJP VHONE �� I.��CENSE • <br />/{'c�G ,QB .233� <br />cm zir vHor+e uccr+;i • <br />�nwee� 77G-$//�y <br />��tzs� ���.�5�.� sGa� � �y <br />��.550. WOP� <br />�NEW ❑ ADDITION ❑ AL7EH4TION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEHT ❑ BUILDINO RELOCATION <br />V�LU�110N Oi WONN �CA57 OF M�IERUL9 PLUS L11001p <br />il4o ODU <br />o[scn�ee wo�ry� // <br />NLaJ %/lvvif,� <br />�DL'.+F58 <br />�j/ <br />TYVE OF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONANOKNOWTNESAMETOBETRUEANDCORRECT �LL <br />FOURLOVIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WI7H WHETHEN SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh4E TO <br />GIVE AUT110RITY TO VIOIATE OR CANCEL THE PROVISIONS OK <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERfORMANCE OF CONSTRUCTION. <br />SIGNAtl1REOF fRAC10RORAUfHORIZEDAGEN� DATE <br />�µ�}I X � -� /o����.5 �/ <br />' ^--- �PPLIC�N SCIiYBU5iNC5:: :kNSlNO <br />TYPE OF EOUIPMENT <br />NITS-N P. EA. <br />ION UNITS-H P. EA <br />P. EA. <br />C UNI75-TONNaGF.EA <br />SYSTEMS-BiU MEA <br />RS-B.IU. M <br />1S_OTU M _ <br />E CDOLERS <br />IVERS <br />ILRN <br />D <br />IGl1NIT- CF.M. <br />TOT�L _ ! <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />f110Nf5Et04G1t NE�RSEIBACN SIOESE19Rf.N VIANLBC NNUMBEfl �UNC��FCn <br />2sr 2 s r-- 7'fL r- �4 �yoy� ��E 3_ys pE� <br />USE 20NE lOf �RE� VAC�Nf SIIE <br />�r S [lICS 1]NO FEES YAtU�TION <br />IYFEOif.ONSL OCGl1�ANCVGROUP NOAFOWEILINGUNlt3 <br />Y h1 <br />si or eio <br />+y . 39E S.£. <br />M sA�2 4.F <br />�CG BY <br />G • �- <br />2 <br />7ED ❑ YES O NC <br />PLRIS CNECItED Bl' <br />}�urrn <br />I <br />: io� <br />12 <br />FON ISSU�NI <br />L.c. <br />auaoir+a s/f,�j*�,�. <br />v�unmum <br />MEf,11ANICRL <br />OTI/EH <br />PENRL7Y _ <br />TOTAL <br />iEE <br />� <br />DU <br />