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AIaPLICATIO�: FOR CONSTRUCT; )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT _ HEATING SYSTEM: CI GAS U ELECTRIC U <br />259•8810 <br />�;� DEMOLITION ! I COMBINATI�3N I I BUILDING I 1 MECHANICAL I i PLUMBING I 1 SIGN <br />01YNER IAAILADORE55 CITV ZIP FHONE <br />B.*i.C.R. Associates. 1429 Bro�dwav. fiverett Wa. 9R2�1 25A-7474 _ <br />lEtl/NT IAAILAD�RE55 CITY ZIP PIIONE <br />A9CHR[C70RDESIGIlER MAIIAUDRE55 <br />CIiV 21P <br />GE�lEP�LCONTR�CTOR 1dAlUDDRE55 pTV z�P 206-336-9�"f9E STATELICENSEII <br />Idelch Enterprises. Inc. P.O.Box 366, 115 Lind Street. Mt. Vernon, Ida. 98273 1092 <br />MECNANIGAL CONiRRG70R IAAII A�DFESS dTV ZIP PIIONE S7�TE LICENSE I , <br />PlUM81NG CONipACTOR <br />CONiRACT FRICE OF WORN <br />PROPOSEO USE OF BUILDING <br />IAqR I1��PESS <br />IE FOO7RCE INV ED <br />e contro�ed burn by <br />re Denartment an t <br />LEG�L OESCf11P710N OF PPOPEAtt �SHOWN BELOW OP ATTACH TWO COPIES� <br />��rReg NE corBNE�'�r, Nfi�, NWti, Th w 94.71' to <br />150' to TPe, etc. (Sec. 17, 'itap 29, R 5) <br />P�RCELTAXID.NUMBER <br />172905-2-005-0004 <br />CONSiqUCTION LOAN LENUE0. ADURE55. TELEPH(N!E NUMBER <br />NO. TYPE OF FIXTUflE OH 1" <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY�WASH BASIN) <br />SHOWF.R <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEa <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFIOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />FOR OFFICE USE ONLV: <br />FRONTSETBr1CN RE�RSE78ACN <br />USEZONE <br />IYfE Of CONSI. <br />SIZE OF B�D(3. <br />OC W PIINLV LOAD <br />REASON <br />INIAKE BV <br />AOEA <br />CITv <br />FEE <br />SUB TOTAL $ ; <br />PEPMIT $ � <br />TOTALFEE $ <br />SIDE SETBACK <br />VACANT SITE <br />❑ ves ❑ No <br />pccuruar rroaowtwxcuxns <br />GROU� <br />FIR[ SPRINKlERS REO'D <br />r�nNs <br />D�TF. <br />❑ YES ❑ NO <br />CITY OF <br />LOCAI <br />TAl( C0� <br />JHONE STATELICENSE� <br />CONiACT PERSON ANU PHONE NO. <br />I HEREBY CEPTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TI1E SAME TO BE TRUE AND CORNECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK 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 />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />�'�---F� r� �syl" f <br />sMN�� iune o�ie <br />Ci1V pU5MC55lICf.liSf. lq <br />OF E�UIPMENT <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNI1 HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WO00 STOVE <br />METAL FIREPLACE (WOOD <br />HEAT PUMP <br />GAS PIPING <br />NUM�ER/- <br />� �J �J <br />BUILDING <br />PLUMBING <br />MECHANICAL , <br />ADDITION�L PLAN CNECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />rueuc wo�Ks <br />TOTAL <br />SU� -OTAL $ <br />PERMi• $ <br />TOTAL FEE $ <br />fl <br />� <br />