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APPLICATIO"'1 FOR CONSTRUCT''�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SVSTEM: ]GAS J ELECTRIC ] <br /> 259•8810 <br /> DEMOLITION � ' COMBINATION I 1 BUILDING �7�MECHANICAL �?'PCUMBING I I SIGN <br /> OWNF 'a� ���IG �I LT ��--Ir�Ylt ZI�VCJ� �IPNONE� lJ W / <br /> �J <br /> iENANI MAII AOONESS CiiV Ii� PNONE <br /> IIACNIiEC10R�FSGNER M1Ui�AppRE55 Crtv I�.� �'HONE <br /> GENERALGONiP�CTON M�RADDRE55 GTY LP PNONE SUTELICENSE� <br /> ME �ti1ry���LONJ� p�/IY M��'9, /A LV'4VV!1` C' � O ( I 1 �� P� 1 W ,V�\ I�Y1nIV�I�� <br /> I\ I I 1!\J 1 I 1 I lN l <br /> PL MBING GONTR�CTOR M�IL�DDRE55 LITV ZiP PHONE ST�TE LICF.NSE� <br /> � <br /> CONTR�GT PRICE OF RK � � V� <br /> OESCRI WORN � �REF GEINVOLVEO CONUC7PER50�+�'in�`HONENO <br /> `�' r � -- <br /> G.- � ,,,,� ',,,. 22- S'(9 I <br /> I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEO USE OF BUIlDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br /> LEO�LDESCRIPTIONOFPROPERTYISNOWNBEIOWORATiRCHTWOCOPIE51 WORN WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br /> �or euxK � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHEH STATE OF LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> PERFORMANCE OF CONSTRUCTIO T I AM AUTHORIZED BV TNE <br /> OWNER OF THIS ROPERTY T ERF RM T WORK FOR WHICH <br /> APPLI ON I WITH THE STATE <br /> PARCELTe%ID.NUMBEH CONT CT 1B.Z7 D OO AC. <br /> CONSTRUCTIONLOANIENDER.�ODf1E5S,TELEPHONENUMBER � � <br /> PROJECT ADDRESS � /'�•F � �"*�"� D�iE <br /> �y+ LIlYB115�Ht55 NS(NO <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE 0�FII(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSE f(l'OIL[T) 0.'C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIF SVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) _�— UNIi HEATERS—B.T U. M _ <br /> SHOWER 1 CIOTHES DRVERS i_ <br /> KITCHEN SINK d DISP V[NTIIATIGN FAN T_ <br /> DISHWASHER RANGE HOOD _ ._. _ <br /> LAUNORV TRAV WATEF HEATER _ i_ <br /> CLOTHES WASHER � WOOD STOVE _ <br /> URINAL ' MEIAI FIFiEPLACE(WOOD BURNIN�) 1_ <br /> DRINKING FOUNTAIN FIREPLACE INSERI T_ <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING .T._.. <br /> ROOF DRAINS—RAINLEADERS EXHA���US7T�FAN� __ <br /> SINK(SERVICE—BAR,ETC.) I �''�7! _ �- <br /> T— <br /> SUB TOTAL 5 SUB TOTAL E �_ <br /> PERMIT $ PERMIT E <br /> TOTALFEE 5 TOTALfEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN RE�RSEiB�CN Si�E5E1flALK PLANf.HECMNOMBER FEE RECEIPTNO <br /> �S <br /> USE20NE LOTAREA V�CANi517E FEES VALUATION FEE <br /> i � � VES .�. NO BUILDING <br /> tYMOFCONSi NOOFSTORIES oca��Nc. 4vaw.�wMauNnS � <br /> �"'"'° PLUMBINO <br /> SIZEOFBLDO FIAESPAINNLEHSREO'0 B�SENFN! MECHANICAL � <br /> � VES �. � NO --- �------ <br /> OCCUP�NCY LOAD FIRE AL�PM REOD HEIGHT UMITATION ADDITIONAL PLAN CMECN _ <br /> ' OTHER <br /> � <br /> ____.___ ______ _ T <br /> RE�SON <br /> • STATE BUILDING SURCMANGE <br /> M1�NE PY � rinNs�nrnoveoe� � CITY OF EVERETT PUBIIC WORK$ <br /> LOCAL SALES <br /> oa,E TAX CODE IS 3105 torn� <br />