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APPLICATIC 1 FOR CONSTRUCT 7N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT L_ <br />259-B010 <br />DEMOLITION COMBINATION <br />TENANT <br />HEATING SYSTEM: U GAS �Id ELECTRIC CI <br />BUILDING MECHANICAL PLUMBING SIGN <br />CITY 1IP <br />OENERAI GOElTRACTOR MAIL ADDRESS <br />� f� ��. <br />96irsr <br />� CITY ZIP <br />'`Ar e raw id s S�a7v 6.5 <br />HONESTATE LICENSE a <br />ME( WIC L ONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />9s 3gz 'wdPK'c e,e 9a <br />PHONE STATE LICENSE R <br />/Y3o.�' <br />r1UMBINO CONTRACTOR MOIL <br />(ADDRESS <br />CITY ` {�Zip'7 <br />S� SOZ/y <br />LICENSER <br />w(E'� <br />USS OF WORK <br />R/r�lJ <br />�—��—'may <br />/SJTATE <br />lf0 //e��O(%„7 lCC� <br />NEW ADDITION ALTERATION <br />REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PIKINE NO. <br />CONTRACT PRICE Cl WOR a W <br />T146_4 <br />DESCRIBE WORK AND ROIURF r. iuvn vvn <br />/I" <br />L..L ocx IIIP IKN! OF PROPERTY (SHOWN BELOW Od ATTACH FOUR COPIES, <br />LOT BLOCK OF <br />' �J 9Xa-AZ - 037-o �D <br />ADDRESS <br />SINK A <br />KS <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO RE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOr,K WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />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 />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27XW AND 296.200 WAC. <br />FORCED AIR SYSTEMS—B <br />UNIT HEATERS—B.T.U. M <br />FAN <br />3 <br />METAL FIREPLACE & CHIMNEY i <br />DRINKING FOUNTAIN , FIREPLACElkzSRi I <br />FLOOR DRAIN ' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS i GAS PIPING i <br />ROOF DRAINS—RAINLEADERS _ ! EXHAUST FAN <br />SUBTOTAL $ ' <br />PERMIT $ PERMIT $ , <br />TOTAL FEE $ TOTAL FEE $ 1 i <br />FOR OFFICE USE ONLY: <br />FRONT SLi BACK RF.ARE <br />Z <br />USE ZONE OT AR <br />TYPE Of CON IS AILOWABLE TYPE Of <br />E BLDG$F +F <br />=SPRNKLERS <br />AMANCY <br />LOAD <br />FIRE AEG <br />N FOR SPRINKLERS <br />SY <br />PLANS APPROVED BY <br />JN 2/t/S3 <br />�..v"�yPM51C /6 oL <br />Fj 1NEv IAN C�CKaUFEEL <br />r -J C/` ) <br />VACANT SITE <br />OCMIWKY IgppAIIAG Lri�15 <br />Ad F <br />_ 3 ' <br />FEES <br />BUILDING <br />PLUMBING <br />BASEMENT <br />O <br />MECHANICAL <br />1EIOHT LIMITATION <br />I <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERE17 <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAI <br />H <br />