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`-1,'�],�i�� <br /> APPLICATI�"1 FOR CONSTRUCT"7N PERMIT � <br /> TO BE COR7PLETED IN BLACK INK-PLEASE PRINT <br /> — ---- ---------- -- - - <br /> BUILDING UEPARTMENT HEATIIJC;SYSTEM: �GAS J ELECTHIC J ___ ___..--..----- _ 1 <br /> zss-ae�o <br /> DEMOLITION COMBINATION BUILDING MECHANICAL X PLUMBING SIGN <br /> OWNF.q MAILADDF655 CitV JiP PHONE <br /> �A�.i�El MoRc-t+� 485`� ALPiA�C (�R EUER� 9�Zc�3 �5�1-c�l��'I <br /> iENANt M1UiLAO�REg•, CRV li[- �'��ONE <br /> AI�CMITECif �ESIGNER MRILA�ORC55 �ITV ZiP PHONE <br /> GfNERRLLONiRRC70R MAILAOORESS CItV ZIP PHONE Si�iEIICEH5E1 <br /> L�CCMRNIGALCONiNACtOR MRiIppORE55 C�T'I ZIP PHONE SIALELICENSE� <br /> PWM9INGCONiRACiOR M�ILADDRESS GTv IIP PNONE STAiELICENSEI <br /> ����� <br /> CONTRACT PBILE OF WOFK <br /> DE SCRiBE WORN ANL SOI/RFE fOOTRGE INVOIVED GONtACT PEFSON RND PMONE NO <br /> _ I��,n <br /> _�'��n GNC/ L-4 �f]lJ(� � _ <br /> i HEPEBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> VHOPOSEU USE OF Ol'Il01NG APhICATION AND KNOW THE SAME TO BE TRUE PND CORRECT ALL <br /> __S_� PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> iecn�oescnivnor+otreoveArrisr�owNee�owoanrrncHrwocories WORK WILL BE COMPLETED WITH 'NHETHER SPECIFIED HEREIN OR <br /> NOT. THE GfiANiING OF A PEFiMIT DOES NOT PRESUME TO GIVE <br /> i-.>r -- e�ocK ov AUTHONITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OF THE <br /> �- PERFORAIANCE OF CONSTRUCTION.IHAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR LYHICH <br /> - - - - APPLICATION IS MADE AND I COMPLY WITH THE STAiE <br /> PARCEI T�%1 D NbMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLORNLENDER.RD�NESS.TEIF.PNONF.NUM�ER <br /> _1L1-� -23 <br /> PROJECTADDRESS =��� � o.ie -- <br /> ac,P�,tiE ��,.A��swtss,��,�..,��, — -- — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE � <br /> ',J, WATER CLOSET(TOILET) Ai;:-�lvHNDLG UNITS-H.P. —T— <br /> �_ BATHTUB FORCED AIR SVSTEMS-B T.0 M E.A. � <br /> — -- y- <br /> LAVATORV IWASH BASIN) UNIT HEATERS-B.T.U. M ' <br /> / SH01hcR (;�C;Hf-SORVERS <br /> KITCHEN SWK 8 DISP VENTILATION FAfr <br /> DISHWASHER � RANGE HOO[1 <br /> LAUNDRVTFAY WATER HEATER _ _i_ <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNT,OIN � FIREPLACE INSERT <br /> FLO0�7 DRAiN HEAT PUMP <br /> BACKFLOW PqEVENTERS ; GAS PIPING <br /> ROOF DtiAINS-RAINLEADERS � EXHAUST FAN —T <br /> SINH(SERVICE-BAq,ETC.) � <br /> ; _- <br /> �— <br /> SUB TOTAL $ 'S ;pp SUB TOTAI. $ <br /> PERMIT $ �UO PERMIT $ <br /> _ 70TAL FEE 5 'pp TOTAL FEE $ <br /> POR OFFICE USE ONLY: <br /> F110NTSEIBRCN REr1N5ETpRCN SIDESEiNnCN PIANCHECKNUM11Eii �FE RECEIPiNO <br /> u.,ezoNe LOi�REA VAGdNTSItE FEES VALUAiION FEE <br /> " ! VES --� NO pWLDING <br /> IYP[GlGONSi NOOFSiORIES aCUP+Ncv xonrmiui�yr,iiw�s <br /> °p"'" PLUMBING <br /> 9Z[OFpLOG RRESPRIHNLEFSFEQ-D 9ASEMENT MECHANICAL <br /> I - YES . � NO � -- <br /> OccUPRNCvlo40 FIRE�IARMRG00 NEIGNTLiMITqiION AL 'IONALPLANCHECN � <br /> OTHLR <br /> i�tnsoN - --- <br /> �IATC OWLDING SURCHARGE <br /> _—__--_- _ _ '—_ _ <br /> vrnKe nv vuNs�rrnovco ov CITY OF EVERE7T PUBIIC N'ORNS <br /> LOCAL SALES <br /> _ nnre TAX CODE IS 3105 TOTAL <br />