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�'' '' . . ,v� <br />, � �,E,,,,,,,,, �PPLlCATIflN F�;,�1 ����, <br />' CONSTRUCTION <br />i Gn Or <br />' everett PERMIT e � <br />� , BUILDING DEPARTMENT <br />' . <br />258•8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />��❑ DEMOLITION ❑ COMBINATION O BUILDING [�•MECHANICAL C9'PLUMBING ❑ SIC3N <br />� _ <br />2 ` OWHEP M4l ���R[SS CIIY lO' PI. NE ,. � � <br />i tiTnl�i� `��_►=l�=k�X- � n,7 -t�CcIC��4CCQ(�� �ut' F��Zilt-1� 4pb'Ln- aLcBC� , <br />' �RCNITE TORDE9iONER M�il�00NE55 _T/ Clrv liP PHONE <br />! <br />� OENENIL GONiR�pOA MA;� �OORE55 Cirv Z�P P��ONE LICENSE • <br />i <br />MECN�NiUI LON*H1CiOfl M�R �DOVE55 CIfY 21P PNONE �-��CENSE • <br />; �,��it,�2A(— ��r�� t'C��iPCc�. i1o;�.,5 E h�«-1�.in� Ui4c��4�P s� �r .��sr���il <br />_... '•. "• n UGENYE � <br />Cf31�1t� ,�/A7l(A'('�!� 3dlK�-/ <br />CLAS90f WORe <br />❑ NEW ❑ ADDITION O AITERATION ❑ REPAIR ❑ DEMOLIT�ON ❑ WOODSiOVE/Ff.Pl..INSERT �] BUILDIN(; RELOCIITION <br />VAL WTIOH OF WOAN �COSI O� M�'. k �IµS PlU4 UBORI ' <br />0 <br />L[O�L OESCRIj�fION O� <br />W�1iEN Gl{ <br />�,:, a�rNtue <br />UVATOf1Y <br />. cun�uco <br />�" ���c� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP• <br />PLICATION AND KNOW TME SAME TO BE TRUEAND COHRECT. ALL <br />OWNBELOWOFATT�CMfOURGUPiE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED MERE• <br />IN OF NOT. THE GRANTING OF A PERMIT DOES NOTPRESUME TO <br />GIVE AUTHOR!iY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANVOTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br />OR THE PC-FFORMANCE OF CONSTRUCTION. .• <br />S��N�TUHE OF CONiR�CiOR ON AUTHORIZEO AGENT DATE <br />X 6�1_�r n r, i.. /_ _, i_ <br />7F fl7ITURF OR ITEM <br />ITOILET! <br />KITCNEN SINK l DISP. <br />DISMWASMER <br />' UUNDRY TRI1Y <br />'� I:LOTMES WASMER <br />URINAL <br />. ;L�,:".' � DRINKIN6 FOUNTAIN <br />FIOORORAIN' <br />_ � n�rrn n�u me�ieu�x <br />7 <br />� ^lRON76ETBIICM <br />� .-I:.'�i� <br />��_� � , <br />+ UiiZONE <br />OF PLDO <br />•cC er <br />— nn�ni <br />I — B�R. <br />fU� TOTAL f <br />/EIIMR 3 <br />TOTALfFE f <br />9 SETB�CK g1�E <br />�pE�' IV�CANTSITE <br />OYES ONO <br />OCC <br />UGEN4EN0 <br />MECMANICAL <br />TYPE OF EOUIPMENT <br />A/C — �/I�NOLO UNITS — MP. <br />REFRIGENATION UNITS — N.P. Fj1. <br />BOILERS — B.T.U./N P. <br />O�5 FIRED A�C. UNITS — B.T.U. <br />FORCEDAIFSVSTEMS—B.T.U. M <br />WALL MEATERS — B.T.U. M <br />UNIT MEATERS — B.T.U. M <br />EVAPORATIVE COOLEHS <br />CLOTHESORYERS <br />VENTIUTION FAN <br />RANGENO00 <br />WATER MEATER <br />wOOD STOVE <br />METAL FIREPUICE 6 CHIMNEV <br />FIPEPUCE INSERT <br />MEAT PUMP <br />6A5 PIPIPIO <br />E%HAUSTFAN <br />� v• ljtuCn,�Fj 7cCt <br />8USTOTAL <br />K�WT <br />TOTAL FEE <br />PUN CHECK NUMBER I FEE <br />FEES VALUATION <br />uNlis BUIl01NG S <br />VLUMBING <br />NECHANICAL <br />OiHER <br />STAiE BUILOING SURCHARGE <br />STATEENERGYSURCHARGE <br />CE Bv <br />PUBLIC WORHS <br />TOTAL <br />PROPERN O`NNERS APE NESPONSIBLE FOR DETERMININO ALL. <br />PROPERTV LINC LOCATIONS AND RELATED EASEMENT9. <br />... . . .�:ti.'.:'b'.1�. FE3.M'a:'. . v�.. ��i�� �! :! � ��slL:i _�: 4 <br />