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APPLICATIQ"' FOR CONSTRUCT�"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION f� COMBINATION C 1 BUILDING f_l MECHANICAL CI PLUMBING I J SIGN <br /> OWNIER MAILADDRESS �7 CITV /- 21P � PHON^E� / <br /> Lt✓/f. �E'rj r✓ � ��oJl�� ��/� [/a�rK T'vede/� /,/c�� c-�S.Sl'�,o�C� <br /> TENANT M.11L A�DRE55 GITY 21P PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PXONE <br /> G�ALCONTR�CTOR /��MAILADDRESS f.ITV ZIP PHONE STATELICENSEe <br /> n�r,�,r �� �n� <br /> MECH ICALCONTRA TOR ADDRE55 CITY ZIP PMONE STATELICENSE• <br /> PLUMBINGCONTFACTOR MAILADDRE55 GTY 21P PHONE SUTEUCENSE� <br /> CONTBACT PRICE OF WOHK <br /> UESCRIBE WORK AND SOUARE FOOTAGE�NVOLVED CONTACT PERSON AND PHONE NO. <br /> � .a T,�-fl�'F — <br /> , <br /> ', I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> . PROPOSED USE OF BUIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> ' LEGALDESCRIPTIONOFPROPEHN�SHOWNBELOWORATTALNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> � �or B�ocK oF NOT. THE GRANTING OF A PERMIT 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 /> ' PERPORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> nWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APr'!.ICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCEL T�X I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRE55.TELEPHONE NUMBER <br /> x � ,��,,�� y-�-� �� _ <br /> PROJECT ADDRESS s e ' o�,e <br /> 1� /� �Q�s cmeu5�NE55UCEn5EN0 <br /> �_ <br /> PLUMBINO MECHANICAL <br /> NU. TVPE OF FlXTURE OR ITEM FEE NO. TYPE OF EUUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC-A/HNDLG UNITS-H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) � UNIT HEATERS-B.T.U. M � <br /> SHOWER ' ��OTHES DRYERS � <br /> KITCHEN SINK 6 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAV ; WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> - DRINKING FOUNTAIN I FIREPLACE INSERT . ; _ <br /> ; FLOOR DRAIN ' HEAT PUMP � <br /> '� BACKFLOW PREVENTERS ; GAS PIPING <br /> �� ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) � � <br /> i , ; <br /> � <br /> , � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> � PERMIT $ PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> . FFONT SETBACK RERR SETBACK SIDE SETBpCN PLAN LNECK yU�E�RT FEE RECEIPT NO. <br /> {� t/V <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES G NO BUILDING � U d�l U� <br /> i <br /> TVPEOFCONS7. NO.OFSTORIES occuPap No0lUwnu4GUNiiS i <br /> �A�P PLUMBING i <br /> SIZEOFBLOG. FIRESPRINKLERSRE�'0 BASEMENT MECHANICAL � <br /> ❑ ves n No <br /> OCCUPANCY LOAD FIRE A1.4RM RE00 MEIGMT LIMITATION ADDITIONAL PLAN CHECK i <br /> i <br /> OTHER ' <br /> FEASON <br /> STATE 9 W LD W G SURCHARGE �� <br /> INTANE BY PLANS APPROVED BY CITY OF EVERE7T PUB�IC WORKS � <br /> LOCAL SALES , <br /> DATE TAX CODE IS 3105 TOTAL �� ; s�j <br />