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s _ �� .: <br /> APPLICATIO'^` FOR CONSTRUCT�'� N PERMIT � <br /> TO BE COMPLETED IN BLACK INiC—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS O ELECTRIC ❑ I <br /> 259-8810 <br /> I� DEMOUTION I ; COMBINATION I-I BUILDING [=1 MECHANICAL if�PLUMBING ❑ SIGN <br /> OWNER MAIL� DFE55 003 CITY ZIP PHONE <br /> �obert't .D S�c�c �,�,e� a6� �r�'dC��ee7t' �RS�_. Td�1lJ/ ar�-3� r6 <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCNITECT OR DESIGNER MAIL AD�PESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MFIL ADDRESS CITV ZIP PHONE STATE LICENSE• <br /> MECHANICRL CONTFACTOR MAIL ADDRESS CIiV ZIP PMONE STATE LICENSE 1 <br /> GGF�'JPh/ <br /> PLUM�ING CONTRACTOR MAIL AOORESS CITY ZIP PHONE STATE LICENSE t <br /> CONTRACT PRICE OF WORK <br />� DESCRIBE WORK AND SOWRE FOOTAGE INVOLVED CONTqCT PERSON AND PHONE NO. <br /> ZN 5�'9��— G.�s i:�af w•¢�c�c 1�i4.1/ <br /> i d- S22(/(`C I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILOING ¢ � / APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �nl//1'L— PROVISIONS OF LAWS AND ORDINANCES GO\'ERNING THIS TYPE OF <br /> IEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWORATTRCHTWOCOPIES� WORK WILL BE COMPLETED WITH WHEIeIFR SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCN ov qUTHOF�TY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PAPCELTAI(I.D.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �� CONTRACTORS LAW 18.27 RCW AND 29/62�00 WAC. <br /> � CONSTRUCTIONLOANLENDER,AUOPESS,TEIEPHONE NUMBER �/� ^ , YL:����/'`i�C"' Y <br /> � ��fi¢l% <br /> iv <br />� � PROJECT ADDRE ' s �rune oue <br />� i � CItYBU5ME55liCEN5EN0 <br /> ' PL BING MECHANICAL <br />` ' N0. TYPE OF FII(TUHE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—NHNDLG UNITS—H.P. � � <br /> i BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> ��� IAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER ' CLOTHES DFYERS � <br /> KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEAfER ' <br /> CLOTHES WASHER � WOOD STOVE I 'i <br /> URINAL ; METAL FIREPLACE(WOOD BURNING� I <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ; �I <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> � ROOF ORAINS—RAINLEADERS � EXHAUST FAN � � <br /> SINK(SERVICE—BAR,ETC.) ; I <br /> , � <br /> ' ' I <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ � PERMIT 5 S � <br /> TOTALFEE $ ' TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REAqSETBACK SIDESETBACK PLANCMECKNUMBER FEE RECEIPTNO <br /> USE ZONE LOi RREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING i <br /> 7VPEOfCONSi. NOAFSiORIES OtCuvµ�v NOCiqv[uiNcuNns � <br /> �Aav PLUMBING � <br /> SIZEOPBIDG. FIRESPPINKLERSPEO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO <br /> OCCUPANCY LOAD FIPE ALAFM FEO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> OTHER � <br /> i <br /> REASON <br /> STATE BUILDING SURCHARGE � <br /> INTRNE BV PLANS APPROVEOBV CITY OF EVERE7T PUBLIC WOflKS ' <br /> LOCALSALES ' <br /> DATE TAX CODE IS 3105 TOTAL � <br />