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�.PPLICATION �0., <br />G «'"°""' �OI�STRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION Q1FIUILDIN�`a ❑ MECNA�NICAL O PLUMBNJG <br />OWNE/R/ /� ' M�IIADDPE55 CIiV i�P PNONE <br />•- [-/ - C D.1I.57,'�'UCTIo�l9 �i, _ /ocY3 lc��[�k1 EVT, N.L4. �8103 )s1- - <br />�e[ui%crnanF�ireEa _ M�IL�OONESS QTY � YiV — PtlONt <br />O SIGN <br />7� 3 <br />GEN�.UL LOI TN�CTOR M�IL �D�NE55 GI�Y LIP YIIONt LICENSE • <br />f%- �tilC d[TKrI� � S�l�r7� A.r R�3dvL _ <br />MIC�IANIC�ICONTP�GiOfl MAIL�UORE55 Cltt 21P PIIONC IiLENSt • <br />PL'JMBINGCUNTp�GION M�ILADORESS GITY IIP PI�ONE UCLNS_• <br />CI�SSOF WONK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ �EMOLITION ❑ WOODSTOVE/FFPL.INSEFT ❑ BUiIJING RELOCATION <br />V�tU�T10NOFWORNICO570iM�fEf1UL5PW5L�BOR1 �— <br />� (p�-ZSG� n � 8�61�p • <br />GESCRIBE WOHN ' <br />�w t��tics�ucrian4 /900 <br />uSEof'v� ,nn; <br />'�," c�• / <br />�.71k/�� --� AC IU �i+.I.. i'P 1 i/�C <br />IEOAl0E5CRIPTIdNOFIAOPERTY MOWNfiELOWOR IT�CMFOIIflI <br />iot � eioc�—�F%`E�/��� I/L.lf�i7rf T� <br />A 3-28-4- <br />WATER <br />KITCHEN <br />..ISEItln4R <br />1 / <br />i/. J <br />USE ZONE <br />�') c� <br />�C � v <br />IYME Oi GONSL <br />I � �' <br />SIIE UI I11114 <br />I HER:�9Y CENT:rY THAT I HAVE READ AND ExAMINED THIS AP• <br />FLICATiON AN�J KNOW THE SqME TO SE: TRUEANDCORRECT. ALL <br />PROVISIJNS OF LAWS AND URDIN�NCES GOVERNING THIS TYPE <br />QF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE- <br />!!i OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVI;iONS OF <br />ANY t)THER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR i'i-iE PERFORMANCE OF CONSTRUCTION. /&, �,� <br />SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT DATE Y <br />X � � /% (A ., <br />�� sT s_ �+/. ���tis�_ i�1 � r. .— <br />MECHANICAL <br />TYPE OF FIXTUHE FEE IiU.� TYPE �F EOUIPMENT FEE <br />r,rnii cn Ud � AIR COND. UNITS-H.P. EA. � <br />-H.P. EA. <br />D AC. l:P <br />AIR iVST <br />M <br />FAN <br />6� <br />UO <br />Sa <br />jv <br />� <br />TFiIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />,RE�NSEIB�CK SIDESETB�GK PL�NGHECNNUAIBER '�(v�I.nNGu[c.nf[E <br />__ ` � I . // / O � / lO.✓ / J FEE �/.� c� R[G�.'ll NO ����+� <br />LOT�HE� VAC�NTS'TE <br />FEES VI1LIl�TION FEE <br />�RYES pN0 -- <br />OCCUP�NGYGA9JP NO.OFDWELLINGUNITS ___ <br />9 <br />NU Of SiOli <br />1 <br />FOFl ISSUANCE 8Y <br />G -� <br />BUILDING <br />PLUMBING <br />MECMni1�L'4L <br />07111'0 <br />PENAL'fY <br />TOTAL <br />=G��+CV•w�.__"__�� OD <br />2 (s� <br />-- -- --- ----- — 2R� SL7 <br />