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AF�IICATION FOR <br />�° °""' CONSTRUCTION � <br />everett PE RM IT e� <br />DEPT. Oi COMMUNITY DEVFIOPMENT SERVICES <br />CITY HALI I59-0715 <br />IVEREii,w�9exot ��OMlINATION � SUILDING ❑MECHANICAL ❑PLUM6ING PERMIT NO. <br />ONNfR Mnll �DDIt155 UTY Z�P �MOMF <br />�P�,�1 A. �U �,I,X.�u ��01 s,s�r.r.�,;., E..�a�tT qx�a� 2sf-6�9/ <br />�R('Miif[tOI1OfSIG�+IR M/.IIeDDN155 CIiY ZIP FlIONF <br />C� L{%A��C <br />LfNill�l[ONiM(l0l M�R�OORf55 CrtY ZiP INONF UGFNSEI <br />44JLIP� <br />�11CM�NIUt COHTl�CIOII Msll eDpNlSS CIIY LIP PHON! ; UCENSE / <br />fII�NPI�.0 NNTMC1011 M�II �DDIIISS OIY IIP PNON( IICENSI � <br />l l U� OI NOII[ <br />❑NEW ❑ADOITION �ALTERATION DREPAIR ❑DEMOIITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDINCRFLOCATION <br />\Ql'UIONOf WOIIF <br />� �5��� <br />IIIN'll�fll W(Nlk <br />1'110M)SI[l DM UI IIU�ID�NG <br />IeL V DlSCRiFLOY Of PROPIRIY �SNOWN III lOw OR �IL�CN VOU� COPp31 <br />ioy 11 eiocK.�.Q�or Al.�l�// L..�.�4�Z✓v�ri <br />1011 �DDI1155 <br />�tUM�ING <br />KITCHFN SIHII L DIS� <br />UUNpRY TR�V <br />CLOTN[5 W�SNFQ <br />DIIINKIHC FOUNTIIIN <br />USF 20Nf <br />TYPE Oi C <br />511E OF BI <br />fIRE ZONI <br />ROOi OII�INS—RAINIF�OfRS <br />lOT �REA <br />B�SfMENT I HIUR(wM5 <br />MMOV�If <br />1 FNVIRONMENUI CNFCK LIST <br />S SUIIDING ►UNS <br />] il�E HYGItANT <br />� i1RF PROTICTION SYSTEM <br />S CR�DIM.IlIICAVATION6ClU�ING/G�UBRINL <br />6 DIIAIN�CE <br />7 fNVlllpt�MENTAL IMPACT STI1ifMENT <br />E NEALiX pISTI1ICT <br />APPII wi�n...����T w�.�crw:rr{n <br />I HEREBY CERTIFY iHAT I HAVE NEAD AND E%AMINED THIS AP• i <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANCES GOVERNINC THIS TYPE ' <br />OF WORK WILL 8E COMPLIED WITH WHETMER SPECIFIED HEREIN I <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PR[SUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS(ONS OF i <br />ANY OTHER STATE OR LOGL LAW RECULATING CONSTRU�TION ,' <br />OR THE PERFORMANCE OF CONSTRUCTION. i <br />SIGN�TURE Of CONTR�CIOR OR �UTHqt1ZED �CENT D�TE � <br />MFCNAHIUL (/ <br />Fff NO. TY►f OF fQU1�M <br />AIR COND UNITS-H V EA <br />RF�RIGERATION UNITS-M P FI <br />POII[RS-HP FA <br />GASfIRED�C UNITS-TONN� <br />FORCfO AIR SY57FM)-B T U <br />WAII ME�TFR$-8 T U M <br />UNIT HFATFRS-0 T U M <br />�{ <br />R[ �R YARD Sf T! <br />MUNT SITf <br />❑YES CHO <br />NO Of OWEIIIM <br />M�% OCC IO�D <br />flRf SPRINKLFRS <br />IIfQUIRfO <br />VfNTIL�TION FAN <br />RANGF HOOD <br />AIR N�NDLING UNIT- C F M. <br />S70VE <br />M{lAl FIRFM�Cf LCHIMNfV <br />PL�N CNFCK NUMBfR <br />i[Ff <br />BVILDINC <br />PWMqING <br />MECN�NIUI <br />�t I D�R 1 OTMFR <br />PFN�ITY <br />TOiAI � <br />Mli { <br />'AL iEE � O <br />PUN CNFIX FFE <br />FEE RECEIPT NO. <br />VAW�TqN it[ <br />S <br />UBC <br />SEC bN+l <br />TOTAL I � <br />►[�MIT V�IID�TION <br />WMfN PqOPfRIY VALIDMFD pN THIS SP�CFI TN1515 VOUR PFRMIT <br />