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APPLICATIQ"! FOR CONS�RUCT"1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />3UILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC ❑ <br />259•8810 <br />DEMOLITION �; COMBINATION I � BUILDING ! i MECHANICAL I�LUMBING I'I SICiN <br />�WNEfl MAILAODRES$ GITY ZIPp VNONE <br />EY%H. T%V�L 323 S'�-iE4QAP� QO � BG�.�,1�4H�1N �ISS%2�✓ i3oo) e"1�-zz'15 <br />EN�NT MAILAODNE55 CITY ZIP PHONE � <br />�RCMITECTORDESIGNER MRILADDRESS CITY ZIP PMONE <br />���no .� '-�lu2�qa '13u� 3�vt¢�•� lA.�E- EVCQE�Y `18203 (200) 353-2F,�p <br />1ENERALGONTP�CTOR M�ILAODRESS � CITY ZIP PNONE STATEUGENSE� <br />LCXti� L�N. SAFAE h5 A�cJE — <br />�ECHPNIGRICONTpACTOR MAILADDRESS CITY 21P PHONE ST�TELICENSE/ <br />MAILA�ORESS Cltt ZIP <br />�¢...acc�...� -B� K43 Wc�er�.�.n.l. � <br />:LASSOF WORK <br />XNEW I I pDDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSEqT I I BUILDINQ RELOCATION <br />/, CONTALT PEHSON �NO PHONE NO. <br />:ONTpACT PRICE OF WppN � c{� �, �� (% <br />�[SCRIBEWORNAN�SOUAREFOOT�GEINV VED1N� <br />F�ff.E pu<hS�u�] sycY��� _ 4 <br />'ROPOSEDUSEOFBUIIDING ' <br />�IJ N\ 1JM5 <br />EWLDESGRIPTIONOFPROVERTY�SNONTlBELOWOR TT <br />OT BLOLK OF <br />S <br />6�� � �as �' <br />� ,«..e �i aio �a <br />�� � <br />'ROJECT�D R <br />- ClT{'O�FF <br />PLUMBING <br />NO. TVPE OF FI%TURE OR ITEM � F <br />WATER CLOSET (TOILET) <br />BATHTUB <br />UIVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />'OR OFFICE USE ONLY: <br />NONTSETB�GK REARSETB�CN <br />�SE <br />PERMIT $ <br />TOTAL FEE $ <br />VACANT SITE <br />O <br />IPEOFCONtS.AIIOWABIE lYPEOfCONSfACiVAI acur�xCr xOabMlUxLuxrtS <br />G�W� <br />.iZEOF9LDG. NO.OFSTORIES BASEMENT <br />1LGUP�NCYLO�D FIAESPRNNLERSREO'D NEIGHTLIMITATIDN <br />VtANE BY I PLANS APPROVED OV CITY OF EVERE7T <br />JM 2.�A%/„ TAX CODE IS 3105 <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OH LOCAL LAW FEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WlTH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />WfE <br />T.U. M <br />GAS PIPING <br />E%HAUSTFAN <br />� <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE $ <br />39 h�� �// � <br />CNNUMBE fEE �/� RE <br />(� <br />BURDING <br />PLUMBING <br />MECHANICAL <br />ADOITIONAL PLAN CHECK <br />SPRINKLF.R <br />STATF BUILDING SURCHAFGE <br />PUBLIC WORKS <br />TOTAL <br />= <br />