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- . �, <br />. �PPLICATION FO._' <br />'".E"'°'"° CON�TRUCTION <br />��r �F <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRIN f <br />❑ DEMOI.ITION ❑ COMBINATION ❑ BUILDING �MECHANICAL <br />OR <br />. . . . � . .. .�:....,: r.;-. ..�::..�._aur��c�x�. <br />❑ PLUMBING ❑ SIGN <br />�n� <br />1�012 '7y� -3906 <br />ZIP PMONE <br />GlNEfl Wrv:R�'CITO-R- / � n MAILAO�RESS t CIN ZIP P110NE /' p LICENSE• <br />Co?`{ h�f/��'nr f'(i QC>x �3�� �C2\r�uc )�� �i1273 ��'/S�-`I/� �oZ�(�%-IS%k4/ <br />MECHANICALGONTRALTOfl MAl1.�DOFE55 C� Z�P PH�NE �ICENSE� � <br />PLUMBING CONTRACTOR M�IL AODFESS LITY ZIP PIIONE LICENSE • <br />,Y�1, NEW ❑ ADDITION ❑ ALTERATION ❑ FiEPAIR ❑ �EMOLI�ION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILD�"�G RELOCATION <br />VRW�TIOI�jO� VC05/��T`,ALS PLUS LRBOHI <br />C( <br />OESCRIBE WOflN Q ^.` <br />��7 i i�%/N� <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PL�CATION AND KNI�W THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED 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 />SIGNATURE OF CON7RACTOR OR Al1THOR12ED AGENT DATE G.�"I�^Ff� <br />X,O,D_/ <br />FEE I NO. <br />REFRIGERAiION <br />BOILERS—H.P. E <br />GAS FIRED AC. I <br />U. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETO�CN REAP SETBRCH SIOE SETBACH PLAN CMECN NUM9EP PLAN CIIECN <br />USEZONE �OTnflEA <br />ttPE OF CONST. OCLIIPANCY GflOUP <br />S12E OF B��G. NO. OF STORIES <br />FIRE SPRINKLERS REOl11RED ❑ YES ❑ <br />PPPIJCATION ACC BY PLRNSCHECHED BY <br />VAGRNT SIIE <br />�YES ONO <br />NO OFOWEL <br />APPii <br />BUILDING <br />L040 <br />PLUMBING <br />MECMANICAL <br />OTHER <br />PENALTY <br />ISSIIANCE BY <br />TOTAL <br />FEES <br />FE! AECEIPT NO <br />VAIIlATION FEE <br />f <br />9 <br />