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APPLICATIC"] FOR CONSTRUCT''1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYS7EM: ]GAS J ELECTRIC J <br /> 259-8810 <br /> OUTION ' COMBINATION i BUILDING MECHANICAL Pl UMBING SIGN <br /> \`ER IAAILpDDRE55 �ITY ZiP PHONE <br /> f�i� � ,PvcKtF2 �0/l5 � y�!-�l,A-t� 1..�. l�,:��,w�,-�c✓� 9<. � � � �U4� �' �c->�� <br /> IENANT IAA��qpDFE55 CItY � <br /> ZIP PHONE <br /> �fiCNRECTORDE5IGNEP fdAILADORF.55 CIiV Z!P PHONE <br /> GEN[RqLCONTRACTOR IdAI�pODflE55 CITY 21P PMONE STATELICENSE� <br /> 1dECHqNICALf.ONTqACTOR MAILADORE55 CIiV ZIP PNONE SiATELICENS[� <br /> PWM9INGCONTRACTOR MqILAD�RE55 CITY ZIP PNONE STATELICENSEx <br /> W NTqACT PFICE OF WOFK '- <br /> DESCRiEE WOHN ANO SOUPRE FOOT�GE INVOLVED CONiALi PERSON�ND PHONE NO <br /> S <br /> i HEREBY CERTIFI' THAT I HAVE READ AND EXAMI�ED THIS <br /> PROPOSEDUSEOFBWLDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGAL�ESCRIPTIONOFPROPERTV�SMOWNBCLOWORATTFCHTVJOCOPIES� WORK WILL BE COMPLETED WITH WHETHEF SPECIFlED HEREIN OR <br /> toT etocK �F NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTF!ORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br /> — PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ❑naee�Tnz in.nurnsea CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> GONSTRUCTIONLO�NLENDER,AODRESS.TELEPHONENUMBER <br /> PROJECT DRESS I X x�run�L� v,�� 1 O•L'L�. °1 " <br /> � � �O ����1' �✓� CRYflO5NC5St2FkGLNO <br /> • � PLUMBING MECHANICAL <br /> � N0. TYPE OF FIXTURE OR�TEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CIOSET(TOILET) AiC—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHESDRYERS <br /> _ KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATEii � <br /> CLOTHES WASHER WOOD STOVE �- <br /> URINAI_ METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DflAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINL[ADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL $ SUBTOTAL $ , <br /> PERMIT S PERMIT 5 <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FNONTSETp�GK REARSETpqCK SIpESETBACK PLANCHE KNUMEER FEE PECEIPTNO. <br /> ��JI� <br /> USEZONE LOiAREA VACANTSITE FEES VALUATION FEE <br /> YES �J NO pUILDING <br /> iVPE01CON5i NO.OFSTORIES 00.uoeNLv rv0o�owRUHGuintS <br /> b��p � PLUMBING <br /> M1� � � <br /> 512E OF�OL��O�G //,y� FlRE SPRINKLEFS REO'D 0 EMENT <br /> NO �/(./sKJ'� Y� �'ES . NO MECHANICAL <br /> OLGIIPANCYL0A0 FIREAIARMREOD HEIGHiLIMITAT10N ADDITIONALPLANCHECK _� � vD <br /> � OTHER � (�I A I IM� y/r 'OO <br /> REAS�O�N�/ .ry^ e//`J�. <br /> (rM��IW /K� r <br /> STATF BUILDIN SURCHARGE <br /> INTAKE BV PLANS 4PPROVED 9Y CITY OF EVERE7T PUBLIC WORKS <br /> c)M LOCAL SALES <br /> ont� 10 Z� TAX CODE IS 3105 TOTAL r,, I O0 <br />