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APPLICATIC- i FOR CONSTRUCT' lN PERMI'� � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ _ <br /> 259-8810 <br /> ❑ DEMOLITION [ 1 COAr1BINATION Cf Bt11LDING Cl MECHANICAL ❑ pLUMBING ❑ SIGN <br /> OWNER MAILAD�FESS GTV ZIP �bZO, pHONE <br /> , ( �IYI S7 Et LC Z23 Z �-o�gry Rl� �E�77 3 'J�j 1 G 3S <br /> TENANT MAIL qDOFE55 CITY ZIP PMONE <br /> OWNL–�. <br /> ARCHITECTORDES16NER MAILA�DPESS CITY ZIP PHONE <br /> S�1ME <br /> GEIJERALCONTRACTOR MAILADDFESS CIN 21P PHONE STATELICENSEY <br /> SAM� <br /> MECHhNICALCONTflAGTOF MAILADORE55 CIN 21P PMONE STAT'cLICENSEp <br /> f�'I A <br /> PLUMBINGCONTRACTOnR MAILADORESS CITY ZIP PNONE STATELIGENSEa <br /> M�!\ <br /> CONTPAGT PRICE OF WORH <br /> /l,20.5- <br /> �ESCR BE WORK AND SOOARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> � J Sw✓��� <br /> i HEREBY CERTIFY THAT I HAVF. READ ANQ EXAMINED THIS <br /> PROPOSEDIISEOFBUILDiNG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALQDE�SCRIPTIONOFPROPEHTV�SHOWNBELOWO7R�ATT,A,C�IiT�WO�CrpIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or '� e�ocK 4��' oF - 'iJ-�(� �� ���'�F_ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> I.OTS I-I— I � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PEPFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> r•�y h _O I� '_Q OWNER OF THIS PROPEfiTY TO PERFOR�,7 THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%i.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUC710NLOANLEN�ER.ADDRESS,tELEPHONENUMBER <br /> X �vw� /L�".Er,� �o I y3 <br /> ?ROJECT A DRES sicNnn onre <br /> 2� U � ���� Ci1v0051NE55ULEN5EN0. <br /> PLUMBING �1ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � !C—FVHNDLG UNI13—H.P. I <br /> BATH7UB ; F CED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN; � UNI EATERS—B.T.U. M ; <br /> SHOWER ' CLOTH DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATIO FAN ; <br /> HWASHER <br /> � FANGEHOOU �— <br /> LAU Y TRAY ; WATER HEATER <br /> CLOTHFS SHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOO URNING) <br /> DRINKING FOUNT � FIREPLACE ItJSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADER � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � � <br /> � <br /> � � <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL 5 <br /> PERMIT 3 � PERMIT S � <br /> TOTAL FEE $ ; TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: �S�S.CJ11t�tC/ CUU✓ <br /> FFONT SETBACN ' REAP SETDACK / SIDE SETO� / PLAN CHECK NUAtB�/ i � �� RECEIPT NO.� <br /> 7 �i <br /> `7 <br /> use zo� � l0T AREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES Cl NO BUILDING Q � /ZQ ; J� <br /> ttPEOFCONST. NO.OFSTORIES ccCuvANCv xO.OvmvEluxGwniS i <br /> _,J / LP0°3 � PLUMBING -T�_ <br /> SRE OF BL�G. FIfiE SPRINKIEPS REO'D BASEMENT MECHANICAL —= <br /> as �� u� ❑ YES ��a ; <br /> OCCIIPANCYLOA� FIREAIARMR[O'D HEIGNTLIMITATION / ADDITIONALPLANCHECK � <br /> u� � �$ � ' <br /> OTHER <br /> FEASON <br /> STATE BUILDING SURCHAFiGE L � Q <br /> INTAKE BY PLANS AFPROVED BY CITY OF EVERE7� PUBLIC WORKS —i <br /> `J I� LOCAL SALES <br /> or,re 9 8 ,�� TAX�ODE IS 3105 TOTAL 2 L� ;� <br />