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APPLICATIG� FOR CONSTRUC'�`1N PERMIT <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br />BUILDING DEPARTMENT L <br />259-8810 <br />❑ DEMOUTION f l COMBINATION 117'�UILDING I I MECHANICAL ❑ PLUMBING ❑ SIGN <br />�WNER M�ILpO�D/ ESS CITY ZIP PHONE <br />ii/l/�// �.�i ,5''..s�,�,r� d FI/,��i�'T% �' �'�2ir � 3 3 9 a� l� <br />TEIiANT M�IIADDPE55 Cltt 21P PHONE <br />Si�/ / its� � li,��� <br />AR„HITECTOR�ESIGNER MAILADORE55 Cltt ZIY PHONE <br />GENE.fM�I.CONTqACTOR MMLAOORESS CITY ZIP PNOVE ST�TELICENSE� <br />�LU/l.,Fl�� <br />MECHANICAICONTRACTOR MAl1.ADDRESS CITV ZIP PHONE STRELICENSE� <br />PLUMBINGCONTR�CTOR M�ILADDRE55 GITV ZIP PHONE STATELICENSE• <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />PNOPpSED <br />LEG�LDE� <br />WORK AND Sq1ARE F(pT�GE INVOLVE� <br />BUIl01NG <br />� <br />IOFPROPEHTY�SHOWNBEL01 <br />— BLOCK OF <br />I.D.NUMBER <br />r7v Gbo -C�c <br />ONLO�NLENDER.AD�flESS. <br />SINK 8 <br />URINAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />CONT�CT PERSON AND PHONE NO. <br />I HEREBV CEHTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OP CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEATV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br />Y 2 //- 9s� <br />SqN�iURE DATE ' <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />FAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAI FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAPSET&1CK SIDESETBRCI� PLAN ECKNU�/yg�/q <br />I /� � r S ��OV <br />CJ✓ <br />��z LOTAREA VqCr1NT51TE _� �E$ <br />— � ��O Z7� � � �ES Ci NO BUILDING <br />TYPEOiCONST IO.OFSTORIES p[cuCeNtv xowMrtwNGUMits <br />I GPW� <br />1 PLUMBING <br />SIZEpFBLDG. FIRESPRINKLERSREO'D BASEMENT � / MECHANICAL <br />Q'�'� SF �(V ❑ YES �'NO <br />OCCUPANICY LO�D FIRE ALARM REOU NEIGHT LIMITRTION ADDITIONAL PLAN CHECK <br />,Yln J Z� OTHER <br />REASON <br />STATE BUiLDING SURCHARGE <br />INT�NE BY PlANSApPROVED BY CITY OF EVERE7T PUBLIC WORKS <br />J I� LOCAL SALES <br />DATE7 /?'� 1Q�1 TAX CODE IS 3105 TaTA� <br />i� <br />� <br />_:- <br />