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APPLICATIC�1 FOR CONSTRUCT )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS J ELECTRIC J 1 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION I COMBINATION BUILDING i ,MECHANICAL PLUMBING I l SIGN <br /> 01VNER MAII ADDRE55 CITY IIP PNONE <br /> 5!A� Oi lA�SHI►��91'rQ�I — <br /> TFNh4T MAiLADDRE55 dTV ZIP PMONE <br /> ��' f¢t^hw�vN�l`1 (�t,l,4�lC Q�I W4tmo2� Av� , I�J4�'c'�" ,InPy • �7A� 3� 9st3 <br /> A9CII�iEGiORO[SIGNER MAILADDPES CITV ZIP PHOIE <br /> W�°5F1� _I°azL4�TCcL`[5 I�ZI �� f�4. N� 9��;;9 7,06 5•�70b � <br /> GENERALCOM1Tfl�CTOR MlILrIUDRESS CITY ZIP oHONE STAi[LiCENSE� <br /> KWf��4,N. CAvT�1E. �1i.11 _ <br /> �nECHANICALCONTRPCTOR MAILAO�RESS CITY ZIP PiiONE STAT[�ICENSE� <br /> P�UMf�IN3CONTRACTOR MMLf.DCRE55 QiV 21P PHONE STATELICENSE� <br /> CC�1iRAC P ICEOF iiK�'� I Q� �1,,,, + , ��� �O♦ ��/ �� <br /> �'a��Ynv �— /(%f1 � <br /> v i���i <br /> U[SCNIEE WpRK�ND SOUIRE FOOTAG[INVOLVED CONTqCT PERSON ANO PHONE NO. <br /> r2wr�ax�,� q� bcti5tt� c�Fcc.�S nr�0 _ <br /> TO�� I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> aaoa seo use ov sui n+c' n r�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> vv l PROVISIONS OF LA�VS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn�oescnianorvoFraoa[aTr�sr WN9LLOWOfiATiACHTIYOCOPIE51 WORK WILL BE COMPL'eTED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PER411T DOES NOT PRESUME TO GIVE <br /> �ot o�ocK oF — AUTIIORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAtANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV 70 PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATe <br /> raqce�tnx i o.r+un+eea CONTRACTO LAW 18.27 RCW AND 296200 WAC. <br /> i 1 <br /> COI:STRUCTION LOFN LENOEF.A�ORE55.TELEPNONE kUMOEN � '� � �� <br /> PROJECTADDRESSQe�� �'TL�y�� n,fp sicnnroac o,+r . — <br /> C1� ��'<<�w f�� L cnrnusiN ..ir� v. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLJSET(TOIIET) A/C—AiHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGF HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER W�OD STOVE <br /> URINAL nti 7AL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN r9 EPLACE INSERT <br /> FLOOR DRAIN HE.aT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SEAVICE—BAR,ETC.) <br /> i— <br /> SUB TOTAL $ ; SUB TOTAL 5 <br /> PERMIT $ PERMIT 5 <br /> TOTALFEE $ TOTALFEE 5 <br /> FOR OPFICE USE ONLY: �o � %. `= <br /> FRONTSETA4CK R@AfiSETBACK SIOESETBACK P��NCM[ NNUM ER FE FECEIPiNO <br /> ' 3 ,J� � `�i„�lJu <br /> useioNe �ornaea vncFNrsite F ES VALUATION FEE <br /> f YES ��� N� BUILDWG � �S I7 � ��iL�j � JL) <br /> IVPEO�CyN51 NOAFST091E5 oc[��avcv NOO�OWEwiieurvrts <br /> I/ — i✓ niq ,a��� � <br /> PI.UMBING <br /> SIZEOFBLDG FlF�SPRINNL[RSREOD BPSEMENT MECHANICAL <br /> �3 0}J 1.. � '� �S : � YES h i NO <br /> OCCUPpM+C�Lono F�i/N[nLnnMnEao H[iGHitnA�ailoN ADDITIONALPLANCHECK <br /> � O / �� _ OTHER <br /> R[ASON — --� <br /> STATE BUILDING SURCHARGE i��� <br /> iN1AKG�V PLAN. 4PPROVE09V CITY OF EVERE7T PUE3LIC WORH$ <br /> �� LOCAL SRLES <br /> � .E 6_ _ y4 TAX CODE IS 3105 TOTAL ������� ; nc <br />