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��PLICATION FO� <br />« �"'°'"" CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />269-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATtON ❑ BUILDING �J MECHANICAL <br />���a � <br />���,�n <br />e� <br />NCi ❑ SIGN � <br />I� _ . — .._.� -- --I <br />� OENEMI CONTR�CTOR M�IL �DORESS CIiY LIV vHONE LIGEN9E • <br />� <br />�I NEGN�NiWLCONiMCTOfl MML�UDPESS 11CIn n��nl �CC.� ��4CENSE� <br />:1/S90F WORK <br />❑ NEW ❑ ADDITION ITERATION ❑ REPAIR_ ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />M.UMlIN6 <br />SE18�C6 <br />USE LONE <br />V6 FOI�NTAIN <br />DRAIN <br />� ORAINS — RAINLEAOERS <br />ISERVICE — BAR. ETC.) <br />{U�TOTAL s <br />rERMIT t <br />TOTAIf[[ 3 <br />R 9ETB�CK SI�E SETMGK <br />�REA WC�NTSITE <br />OVES ONO <br />IUF�NGYGROUP NO.OFDWELIIN <br />OF STOPIES M�X.00C. LOAO <br />•CCB� IP��NSCHECItEDBY <br />er <br />I HEREBY CERTIFI' THAT I HAVE READ .+ND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TOBETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESOOVERNINCaTHISTVPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. 7HE GRANTIN6 OF A PERMIT DOES NOT PRL'SUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REQULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. '. � <br />SIONATURE OF GONTR�CTOR OR AUTHORIZEO AOENT DATE <br />_p� � � 1 � / Q�_�// <br />X�UY\� �.C,l �� �' :� ` /� 0 0 <br />�PPLICANT.CITYBUSINESSUCENSENO ���- <br />MECHANICAL <br />NO. T1fP! OR EOUIPI <br />IVC — AMNOLO UNITS — M.P. <br />REFRI6ERATON UNITS — M.P. I <br />BOIlERS — B.T.U./H.P. <br />GAS FIRED A.0 UNITS — B.T.U. <br />FORCED AIR SYSTEMS — B.T.U. <br />WALL HEATERS — B.T.U. <br />UNIT MEA7ER3 — B.T.U. <br />VENTILATION FAN <br />RANOE FIOOD <br />WATER NEATER <br />wOOD STOVE <br />METAL FIREPUCE S CHIMNEV <br />FIREPUCE INSERT <br />MEAT PUMP <br />QAS PIPINO <br />E%H�USTFAN <br />su� ror�u <br />KIIWT <br />TOTALFlE <br />PLANCMECNNUMBER �FEE <br />EA. <br />RECEIPT NO. <br />FtCJ •w�uw��vn <br />BUILDING S <br />PLUMBING <br />MECMANICAL <br />OTHER <br />STATE BUILOIN6 SJRCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERN OYJNER9 ARE RESPONSIBLE FOR DETERMININ4 ALL <br />PROPERTV LINE LOCATIONS AND REUTED EA9EMENTS <br />'.` . . 1 ; l, , . . <br />.'t <br />