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APPLICATIC I FOR CONSTRUCT' IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: '2kGAS ❑ELECTRIC ❑ <br />259 8810 <br />I i DEMOLITION COMBINATION ! I BUILDING I MECHANICAL H PLUMBING [I SIGN <br />wl <br />C <br />m A19E <br />ARtIRITEtT d1 DlAAYER LIAA ADCREM Cm EP RCNE <br />OENERM CafrRACTOR WE AWR[M TNT, m HRCRE ETATEHIxMeE <br />1EfMyi4fANiRILEDR wt AOINN" cm 0 RC1E STATE E1LENEE• <br />fUR'6TtGA f'LiY i..n-f A DE , m ,ONE <br />EJK E LCEM. t') <br />f><fMeMo coNTRAcroR wEADpEM clTr n HRCRE sale LCFMRE• <br />FAHTMCT AKi V WafA <br />R Sq Q <br />DlICNEI MaF YC WMK N»IME MRKD <br />CdrAC1 Ef11WN NCHCEE NO Z <br />Ole, <br />I HEREBY CERTIFY THAT I HAVE REF. AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER 3PECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RC W AND 296 200 WAC <br />NAsoMo V!E EY ALLDIq <br />C <br />LEDAL QELrYITdOPRpfRn1MQM1A[HXY OR AnACH INCCOFEEI <br />LOT- saa a <br />rafter. TAX ID NOARR <br />CONXTICTM LOMfENDER. f"M. MEFWNF HOAXERPROJE <br />ADDRESS <br />4gL.L e <br />taw w� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO <br />I TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A C-A HNDLG UNITS-H P <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />LAVATORY IWASH BASIN) <br />UNITHEATERS-B.T.U. M <br />�— <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 6 OISP <br />VENTILATION FAN <br />T_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOWPREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS_ <br />_ <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC I <br />_ <br />SUB TOTAL f <br />SUB TOTAL $ <br />PERMIT f <br />_ _ <br />_ PERMIT E <br />TOTAL FEE f <br />TOTALFEE S. <br />FOB OFFlCF URF ONLV- <br />iRJNT Y1dCR <br />AIMEETMCR <br />mUOIACR <br />I ,, <br />RECEPrrq <br />flee mNE <br />wr AREA <br />mwTun <br />7 YES n NO <br />FEES <br />VALUATION <br />FEE <br />SUILDING <br />--.. <br />PLuueING <br />. <br />TRIatEEET <br />No veTdEe <br />EwafET Ao sewu.uEn <br />R'°P <br />EOEOFMDO <br />FM V11YOEM MOD <br />AASENENT <br />Ll YES n NO <br />MECHANICM <br />ADOtTK)NAI PLAN CHECK <br />OCCfIPM1CT LOAD <br />FEE NARY MOD <br />m[XlWtMRATCN <br />OTHER <br />MAXON <br />STATE MADARD SURICWIROE <br />RIME W <br />HATE AFRIROEEDIY <br />DATE <br />CITY OF EVERE71 <br />LOCAL EALES <br />TAX CODE IS 3105 <br />PlR&IC VA]RNS <br />TOTAL <br />