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APPLICATIQ'"' FOR CONSTRUCTC'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> CHEATING SYSTEM: C7 GAS ❑ELECTRIC ❑_ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i I DEMOLITION IJ COMBINATION fJ BUILDING uyMECMANICAL GPL�MBING f ] SIGN <br /> ON?!E MAIL RODPE55 CITY ZIP VMONE <br /> Pi-��� Sh���n ��a.1 W-E�-wv�r� A-o �i£s'd� l <br /> TEN�NT MAIL AD� Sa GTY ZIP PNONE <br /> �.,, , � 1 _ '/hassa�e .S��ol <br /> �RCMiTECTORDE5IGNER 1.1�LLAD SS CITV ZIP PMO4C <br /> GENERALCONTR�CT R M�ILADDRESS CiTY 21P PMONE STqTEUGENSEI <br /> �I LSD'N �'7iiJ C <br /> MEGHANIGN CONTR�CTOR MAIL�DDNESS ��TY ZIP PNpNE SipTE LICENSE . <br /> PO . �o - _ — //4 -fiZ-6S/ 1� <br /> PLUMBINGCONTRRCTOR MLADDRESS CITV ZIP PHONE 57ATELICENSE• <br /> CpNTR�CT PRICE JF WORK <br /> � ���. � <br /> DESCHIBE WORK�N�SOURFE F TpGE IhVOIVED LONTRCT PEPSON AND PMONE NO <br /> I�.� <br /> T��.J k %N 4G /NTU — <br /> C uN i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vaovoseouse �Fem���� C� / APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> 3 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDE5CR1'TKKIOFPROPERTVIS WNBEIOWORRTTRCHiWOCOPIE51 NOT THELGRA TN�G OF A ERMITVDOES NOT PRIESUMEETO GWE <br /> �or eioc� oF AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PPRCEL T�%I D.NUMBER CONTRACTORS LAW 1B?7 RCW AND 296200 WAC. <br /> GOr15TRUGTION LOAN LENOER.ADORESS,iELEPNONE NUMBER �� ( � �/✓/� <br /> \ <br /> X v o�r��T <br /> PROJECT ADDRESS sa� uar <br /> f.iiv BUSIVF55l�LENSE 1q <br /> PLUMSING MECISANICAL <br /> Wp, TYPE OF Fll(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CI.OSET(TOILET) AIC—PJHNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—P.T.U. M <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAFi.ETC.) <br /> i <br /> SUB TOTAL $ SUB TOTAL $ '00 <br /> PERMIT $ PERMIT $ �� �OO <br /> TOTAL FEE $ TOTAL FEE 8 'Ud <br /> FOR OFFICE USE ONLY: <br /> FHONT SETBRCN RERR SETRRGN SIDE SETPRCK PUH CMECK NUMBER FEE RECEI�T N0. <br /> USEZONE �otnAen vacnr+rsire FEES VALUATION FEE <br /> 1 YES ��' N� BUILDING <br /> TVPEOiCONSt. NOAFSTOPIES o[cuo�u,v xo0rewnuvci:rrts <br /> Y <br /> �"`w° PLUMBING <br /> SIZEOFBIDG_ FIRESPRINKLERSNEOD BASEMENT MECHANICAL <br /> ❑ VES L NO <br /> OCCUPRNCV LOAD FlHE ALRRM REOD HEIGHT LIMiTRT10N <br /> ADDITIONAL PIAN CHEGK <br /> OTHER i <br /> REASON <br /> STATE 9UILDING SURCHARGE <br /> INTPKE BY PlANS APPROVEO BY CITY OF EVERE7T PUBLIC WORKS <br /> LOCIIL S11LES <br /> oATE TAX CDDE IS 3105 rorni <br />