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APPLICATIO"�: FOR CONSTRUCT( �N PERMIT � <br />TO BE COMPLETEG IN BLACK INK—PLEASE PRIIJT <br />ti��� <br />HEATING SYSTEM• �GAS U ELECTRIC O <br />BUILDING DEPARTMENT � <br />259-SH10 <br />❑ DEMOLITION ❑ COMBINATION ! I BUILDING I_I MECHANICAL ❑ PLUM9ING ❑ SfGN <br />OWNEF MAILAO�RE55 CITY Z�P PNO�IE <br />1 � v��'r �-SSOG� I�0'a �� (-:verel--�-��ull lA)c��/ ��6�� <br />TEN4N MlILADORESS CIiY ZIP PNGNE <br />� II.LS �1 . _ 3��% -�553.�f_ <br />ARCHRECTORDESIGNEP MAILADGPESS GTY 21N PHONE <br />GENERALCONTflACTOR MAILADOPESS CITY ZIP PHONE STATELICENSER <br />MECHANICALCONTflAGTOR <br />PLUIdBING CONTPACTOF <br />MFIL ADDRESS <br />MAR AGDRESS— .;�3' � <br />WNTRACTP IC/EO�/F�WORNO� <br />�W . _ <br />�ESCFIBE WORN AND SOl1APE FOOTAGE INVOLVED <br />� �eEvJC �'D C�-�NC <br />�u�P• �2� f-{v-�`�-� fz.� � <br />PpOPOSEU SEOF0l11LDING <br />LEGAL DESCRIPTION OF PROPERTY �SHOWN 9ELOW OR ATTACH iW0 r,pplES� <br />LOT BLOCK OF — <br />PAPCELTAXI.D.NUMBER <br />CONSTRUCTION LOAN LENOEF, AD�FE55, TELEPHONE NUIdBER <br />PROJECTADDRESS <br />i� <br />WATER CLOSET(TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRIMKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />fRONTSETBACK REARSETDALK <br />USE 20NE LOT AREA <br />TYPF OF CONST. <br />SIZE OF BLDG. <br />OCCUPPNCVLOAD <br />REASON <br />INTAKE 8Y <br />SUB TOTAL 5 <br />PERMIT a <br />TOTAL FEE S <br />FIRE SPRINKLERS RE�'D <br />FIRE ALpRM PEO'0 <br />PLANSAPPROVEOBV <br />DATC <br />CITY <br />ZIP PNONE STRELICENSEA <br />�V I+� '� <br />21P PHONL STATELICENSEa <br />�03`7 ?rZ-6z�o W�u.tMi o$8�'A <br />CONiACT PERSON AND PHONE N0. <br />��- LL� �11.F�1�-� �{2-�Z-jO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THiS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. l�LL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT 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 />OWNFR OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR�� �; AW 18.27 RC)NAND �6200 WA\C. <br />/ <br />FEE NO. TYPE OF EOUIPMENT FEE <br />� A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATERS—B.T.U. M <br />� CLOTHES URYERS <br />; VENTILATION FAN <br />RANGEHOOD <br />; WATER HEATER /97 � <br />WOOD STOVE <br />; MF.TAL FIREPLACE (WOOD BURNING) <br />� FIREPLACEINSERT <br />HEAT PUMP <br />' GAS PIPING <br />� EXNAUSTFAN <br />SI�E SETBFCK P�AN CHECK Nt1MBER FEE <br />VACANT SITE FEES <br />U YES ❑ NO BUILDING <br />OCCJPANCY NO.OfN9FLlINGWll15 � <br />cnour PLUMBING <br />BASEMENT MECHANICAL <br />❑ YES Ci NO <br />HEIGHT �IMITATION ADDITIONAL PLAN CHECK <br />OTHEF <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETf PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 rora� <br />PERMIT <br />TOTAL FEE <br />RECEIPT N0. <br />i <br />�y <br />9 <br />