Laserfiche WebLink
� <br /> AI'PPLICATIr '� F�R CdN5T'RQJC7�UN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rr <br /> BUILDING DEPAR��M��NT HEATIN^u SYS'fEM: I]GAS U ELECTFIC ❑ <br /> '59-8810 <br /> I� DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEfl MFILAD�RE55 CITY ZIP pHONE <br /> N1C� MAt� �� �a� ir'�'" �avz n� txtl��u� 98��y ��So_a�,o5 <br /> TENANT � MAI�ADDRE55 qTV ZIP PMC:JE <br /> hl �n��5 <br /> ARCHITECTOR�E516NEP l.IAILADDF,cSS CITY ZIP PHONE ' <br /> w"�� �v. rc�l�nii�cnCoitS,�l{int, I$�I`S �J�� q�R � Kc�-+t �11iO3� �" I - /o.Ja.2 <br /> GENERAL6ESNTflACTCR MAILADOR 5 CITV ZIP PHONE STATELICENSEN <br /> S�� ������� � • i's,x Ir 8`� �ralcvue. �iFonG , .� q 3-ai <br /> �tEC11ANICPLCONTF C� TOfl MAILADDFESS CITY ZiP PHONE STATEUCENSEi <br /> '�/Z:'U5'47 <br /> .��r•�-1l �tve C. �c{c .�< �-1�,1�7 ��!'ir�hl rr4 Ini•'.r. n L�A �f3'�lLoCo .� ��f i-�-�.{ fb11C �> 1 <br /> PLUMBING LONTRACTOR V MAIL AD�RESS CITY ZIV PHONE STAiE IICENSE p <br /> C0IJTRACT PflICE OF WOflK <br /> �a�. � c�9 . on <br /> UESCRIBEWOflKANDSOUAREFOOTAGEINVOLVEO � � , I� / CONTFCTPERSONANDPHONENO. <br /> �,v� <br /> �n�: p11r� 'm� n��1 n'�� �� l�i � �' ' i'vl. _ (aOlc� ���.3-lo��e�7 <br /> 1 <br /> 21 N D5 i- <br /> �� �� �3 ��' I HEREBY CFRTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSE OFBUILDING P qPPLICATION AND KNOW THE Si\ME TO BE TRUE AND CORRECT.ALL <br /> ���^+����rc���-� s'�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE JF <br /> LEGALDESLRIPTIONOFPROPEFTY�SHOWNBEIOWORARACHTWOCOPIES) WORK WILL EG COMPLETED WITN WHETHER SPECIFIED HEREIN OP. <br /> �oT e�o;,K_, aF NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br /> — AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULA?iNG CONSTRUCTION OR THE <br /> " ' � PERFOFMANCE OF CONSTRUCTIOid. fHAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFl7RM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUM6Efl CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> LONSTRUCTIDNLOANLENOER,AD�RESS,TELEPHONENUMBER <br /> � �1�2a'1 ] ��J��i"� <br /> PR ECT ADDflESS � � 1 I I S�GNALUNE / pAIE <br /> � F�Ievnre'n W L1 I C�OOCQ�� � V ��I -��nl CIiY0051NE55LICENSEN� <br /> PLUMBING � MECNANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNQLG UNITS—H.P. ; <br /> BATHTUB ; FORCED AIR SYSTEidS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATEFiS—B.T.U. M i � <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVF <br /> URINAL ; METAL FIREPLACE�WOOD BURNING) <br /> DRINKING rOUNTAIN i FIREPLACE INSERT ' <br /> , <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVEIJTERS ; GAS PIPING ; <br /> HOOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE--BAR,ETC.) ; ; . <br /> Q � <br /> � , <br /> ' ' :i�� <br /> � <br /> � , <br /> � SUB TOTAL � ; SU8 TOTAL $ ; <br /> PEfiMIT $ � PERMIT S ; <br /> TOTAL FEE 5 ; TOTAL FEE 5 � <br /> FOR OFFICE USE ONLY: S I Lo , f � 0)') �/�p� <br /> FRONT SETBACI< RERP SETBACN SIDE SET�ACN PLAN CHECK ER FEE/ PECEIPT NO. <br /> � "����5 /f7s�g <br /> usezoNe LOTAREA vncntir5i7E FEES VALUATION FEE <br /> f� YES fl NO �UILDING i <br /> lYPE'O'�F''fC�O'N�Si.� NO.OFSTORIES OC[UVAY.Gv ImAfO}VVyFLU^HGuui15 <br /> •jLJ'/�.J �j�P N 1 <br /> .� PLUMBING � <br /> 52E OF BL�G. FIRE SPRINHLEflS REO'U BASEh/ENT MC-CHANICAL � <br /> Y�'� f7 Y'ES �NO <br /> OCCl1PANCYLOAD FIREA�lf�P61flE0'D NEIGHTUh11TATIOH ���ITIONALPLANCHECK � <br /> I� -.QIMEF— � 7 �� <br /> REASON <br /> MI'rj l ' C� �/��f�UG,�i- STATE BUILO G SURCHARG[ i _ <br /> ru,� iai <br /> INTANf OV PL�NSA PfiOVED OV CITY OF EVERE i� PUBLIC WOFKS � <br /> � LOCAL SALFS � <br /> onTe � C q TAX COOE IS 3105 TOTAL i <br />