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r.PPLICATION FOk' PTl <br />T"°E`°'`'°'" CONSTRUCTION F6 <br />❑TI Cf <br />everett PERMIT <br />TO BE COMPLETED IN <br />BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS <br />CITY ZIP PHONE <br />EvSPC/T <br />�o E F,A sr <br />pIIONE <br />ARCXIfECT UIIDESIGNER NAIL ADDRESS <br />CITY <br />GENFRAL CONTRACTOF MAIL ADDRESS _ <br />CITY ZIP PHGIF LICENSE <br />(�rtu�ut 98ou8 7a'G'7Ts/ <br />7e-ly eoas,_ /7Y9 -/62�/� <br />LICENSE <br />21P PHONE LICENSE <br />MECHANICAL CONTRCIOR MAR ADDRESS <br />CITY <br />PLUMBING IAATMCIOR MAIL AOORCH9 <br />CITY ZIP PHONE LICENSE f <br />CLASS 61 WORK <br />❑ ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT 0 BUILDING RELOCATION <br />® NEW ❑ ADDITION ALTERATION <br />YALUADONOF WORRICOST Of MATERIALS PLUS LABONI <br />y uo <br />DESCRIBE WORK <br />/ R /9 •n.?c 61VA o <br />i <br />GIVE <br />fC <br />C' <br />H <br />H <br />r+ <br />f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />f <br />- --- <br />FRONT DEIBACK BEAR BE TBACR f SIDE BEIBALR f <br />T LRAM CHECK fFf <br />/ PLAN CN CK NUMBER FEE p•/ RFL�IPI NO <br />., .wE I <br />R. <br />USE20NNE� LOTAREA VACANT OYES BSIT <br />FEES VALUATION F99 <br />0 <br />TYPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br />Zj _Al - / 0 <br />BUILDING 5Tn <br />SITE OFJrBLDG NO OF STORIES MA, DOC LOAD <br />DI <br />• / <br />L K J( Z T I. S7G <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED O YES NO <br />OTHER _ <br />• <br />• <br />PENALTY __.. <br />K <br />APPLICATION ACC BY PLANS OHECKED BY APPR TOR ISSUANCE <br />By �O <br />/ <br />��j � • G <br />TOTAL <br />.�1w _ T,t - ?ii e-2F'l✓ �t�..t� �'f•r-�r°t.E-/-�RF' <br />f <br />U/f%' <br />yN <br />1 <br />t <br />S ro.(Y @�,t t ,v <br />uBE of euILOINa <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br />PLICA710N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF/IgPEITTY IBNOWN BELOW OR ATTACH TOUR COPIER <br />LEGAL DESCRIPTION <br />OF WORK WILL BE OMPLE EDDWITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />ANY OTHER STATE ORLOCAL LAW REGULATING CON97RUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />ST <br />APPLICANTS Clry BUSINf S9lICEN9I NO <br />PROJECT ADDRESS <br />MECHANICAL <br />— <br />PLUM <br />NO <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />AIR COND, UNITS -HP EA <br />WATER CLOSEryTO1LET1 — <br />REFRIGERATION UNITB-H P. EA. <br />BATHTUB <br />BOILERS-M.P. EA <br />LAVATORY WASH BASIN) <br />_ <br />