Laserfiche WebLink
Idly APPLICATIL A FOR CONSTRUCT _ dN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT L HEATING SYSTEM: U GAS U ELECTRIC U —� <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS <br />CITY TIP PHONE <br />74-L Bc­TEL+/c, cv./ P.o 3"7("7 MI5of�-jo W. y,y <br />81z_�l2- <br />TENANT MAIL ADDRESS ~ CITY Zip <br />_ ]A-- Nl I PHONE <br />ARCIATECT OR DESIGNER. MAIL ADDRESS CITY TIP PHONE <br />�V-FM�U Ei�LI(��t✓2S <br />........w,.mo CITY ZIP PHONE <br />/ L--) T i/!'-.V f STATE LICENSE R <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE l ICENSE R <br />NEW ADDITION VALTERATION RFPAIN noun. I.,., <br />------ MUILUINU RELOCATION <br />77 ..�p <br />CONTRACT PRICE I d C(r <br />CONTACT PERSON AND PHONE NO <br />OF WORK .PS�� Cl �' <br />(�C: JA/ A ,Ll4-5 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />G/c- l/Crir,, ­i1LA-7-10 <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />!i"SS 45:­T6 t- y <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK 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 />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 18 277 �RCW AND 296.200 WAC. <br />PRaI:cT ADDRESS <br />DATE <br />3�"j w, CT1sY,vd 29. �fu-22. <br />(ITY BUSiNe SS tICI NSE NO ' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />ATC—AHNDLG UNITS-li P <br />I <br />BATHTUB <br />FORCED AlR SYSTEMS—B.T.U. M E.A. <br />L,%VATORY (WASH BASIN) <br />UNIT HEATERS. -BTU M <br />- <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK d DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY _ <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />I <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />a <br />C�d� i d0 <br />TYPE Of CGIITS ALLOWABLE <br />TYPE Of CONST ACD)PL <br />Occ.'"cl <br />_P <br />NO OTDA[LiAGUNUs <br />PLUMBING <br />i <br />31ZE OF SLOG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />OCCUPANCY l0.A0 FIRE SPRINKLERS REOD HEIGHT LIMITATION <br />/ <br />'ore Doc t oL J?A Yxs <br />REASON FOR SPRINKLERS <br />ACQLiQftAIL PLAN CHECK <br />i <br />SPRINKLER <br />�DPEJ <br />STATE BUILDING SURCHARGE <br />If IS.. <br />/ <br />INTAKE BY <br />PLAN APPROVEDBY <br />IAI/1/_EA` <br />CITY OF F.VERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />TOTAL <br />TAX CODE IS 3105 <br />