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,MEw,,,�„ .-.PPLICATION FO► ���,�„ <br />°�n°� CONSTRUCTION 0 <br />everett PERMIT <br />BUILDING DEPARTM[NT <br />259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION C1 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER ' M4L�DORE55 � �t..��v � C � JP PIIOy E <br />titie� ��wn,' Se��t(�c�' ,ire�S' LR e �,��f;c�r/ 1J.1>a �i,7.�3 3�3-6E33 <br />ip�7 OR OF9GNEB <br />'T'� j''y' <br />�lUMpiN �CONIR�CiJR M�II App�[SS CITV IIP PIIONE IICCNSE • <br />NEW ❑ ADOITION ❑ ALTERA710N ❑ R[PAIR ❑ DEMOlI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILD�NG RELOCATION <br />�wonn �ws u. n�a wo.�o riva uu�m <br />CU�% <br />W HN <br />)�-�R�( �.� <br />iLRIPiION O� PNOPERTY �SMOWN OEIOW ON Rlj(CH f OOR COPIE51 <br />D� ('x'uCr�y ra.-K <br />_BLOC OF <br />C�� Sr%,E�ra� jJ,� ��r.�"7.1'' <br />�pOPE55 <br />NO <br />TYPE OF FI%TURE F <br />WATER CLOSET �TOILEn <br />BATMTUB <br />LAVATORY�WASM BASIN� <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />�i5HWA5HER <br />LAUNDRYTPAY <br />CLOTHES WASMER <br />WATEH I/EATER <br />UFINAL <br />�PINKING FOUNTPIN <br />�RONi SETBAGI( <br />^ L, <br />-N <br />� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. � <br />SIGNRTURE OF CONTRRCTOR OR RUTHORIZED RGENT DATE <br />X <br />Ni5 CIiV pU5iNC55 UCENSP NO <br />INICAL <br />TYPE OF EOUIPME <br />AIR COND. UNITS—HP EA. <br />REFRIGERATION UNITS—M.P. EA. <br />AIR SYSTEMS-8.T <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />•PPUGiIONACC BY <br />� <br />7o�(r t <br />12. 450 <br />PUNS CMECeED E <br />/ — <br />� <br />VACANT_ S�TE <br />ores p�o <br />no or owEuinc ur�rts <br />-e�- <br />MAc OCC. LOAD <br />BUILDING <br />PLUMBING <br />MECHANIGAL <br />OTHER <br />PENA�TY <br />TOTAL <br />���� IFEE �IO�IRECEiPiN0�3y�g <br />1 <br />FEES V�W�TION fEE � <br />