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APPLICATIC� FOR CONSTRUCTP'1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J <br /> 259-8810 <br /> / DEMOLITION COMBINATION BUILDING MECHANICAL J PI.UMBING SIGN <br /> 1 OWNEfj ' MAIL F RE55 <br /> V-_ CITY �p pH <br /> —1�1»i/c�P/� ,l� ooJ 7Ln�a 7'IG /9a� l��.P/� Ge D// /��s %��— <br /> TENqNT /�� IAAI�qODR S <br /> �J � •�- a 2� Ct,i,,,3,P t-'�k.-�� ?�3��bg <br /> ARCHiTECTO '�GNER i AD RE55 _/O ����7y� Z�� pHpryE <br /> � ' � <br /> siE AL CON ACiO? M Il AD�RE55 UTY ZIP f�NpNE STAi �ICENSE� <br /> r� �?4'�► �n.� b7t7 S l�� S� s(,�4tTt� �v�' 7b��y�o S�7r���o�C� <br /> LMEGHAN��ONTRq�TOR IARILADDRESS CITY 2iP PHONE $TATELICENSEt <br /> PLVMBMG CONTRACTOR MqIL qDDRE55 QTY ZIP PHONE STATE IICENSE• <br /> CONTqACT .E OF WORN <br /> �CPIBE WORK AND SOUARE i00TAGE INVOLVED LONTAGT PERSCN AND PN E N0. ��^ r��iy� <br /> // L / [/-f / L S V <br /> /1 /7�— /1Q/� /�G�/sl /n� <br /> S� ��j�'�� �" � 5 I HEREBY CERTIFV THAT I HAVE READ AND EXAM�NED THIS <br /> PPOPOS se 'aoiN� APPL�CATION AND KNOVJ THE SAME TO BE TRUE AND CORRECT.ALL <br /> R� i 9OVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecnioe cRmnorvocraoPearr�sNov.reeiowoaar.ncHnvocoPms; W�qK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> toT e�ceK oF NC�.. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> P JTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> JTNER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PfiOPERTY TO PERFORM THE WORK FOR WHICH <br /> aaace�rnxioNUMee APPLICATION IS MADE AND I COMPLY WfTH THE STATE <br /> 5���� ' OfA �' CONTRACTORS � 18.27RCWAND296.200WAC. <br /> � <br /> CONSTRUC710rv LOAN LENDEF.ADDRE55.TELrpHdJE NUMBFR <br /> P�—CT ADDRESS ^—c�lO � �,uq� 4 I �rI�17� <br /> `�,J o�,c <br /> cnv nusm�ss i�ct as� <br /> PLUMBING MECMANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILET� � A�C—A�HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIt�) UNIT HEATERS—B.T.U. M <br /> _ HOWEfi CLOTHES DRYERS <br /> K HEN SINK 8 DISP VENTILATION FAN <br /> DIS ASHER RANGE HOOD � <br /> LAUND TRAY ; WATER HEATER <br /> CLOTHES HER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> ORINKING FOUNTAI FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF OFAINS--RAINLEADERS EXHAUST FAN <br /> SINK(SERVI�E—BAR,ETC.) � <br /> � � <br /> - T <br /> _ SUB TOTAL $ i SUB TOTAL $ <br /> _ PEFiMIT $ � PERMIT $ <br /> TOIALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FPONTSETB�CN PEANSETBACN SI�ESETBACN PLANCN�CKNUMBER FEE � REC[IP ���/y <br /> (% <br /> use zone ioT aaen vncnrvt sire FEES VALUA ON FEE <br /> ; :�� YES ❑ NO BUiLDiNG ' <br /> TVPEOif,ON51. NOAFSTORIES ouUwx;v NoaoWnu4Guuit6 I —�-} �_ <br /> Gp�'v PLUMBING �j � <br /> � SREOFBLDG FIRESPRIP'RLERSREO'D BASEMENT i <br /> MECHANIGAL <br /> !—i YES ❑ NO <br /> , OCCUPANCYLOAD FlREhLARMP[OD HEIGHTLIMITATION ADDITIONALPLANCHECK <br /> I ' _ OTHER �. �D � O� <br /> f�EA50N <br /> T <br /> • �- � � STATE�UI DING SUFCHARGE <br /> IHinKC9v PLANSAPPROV[OBY CITYOF:VERETT PUBLIGWORNS <br /> JM LOCAL SALES <br /> oATe �z /b q3 TAX CODE IS 3105 rorn� � ; �p <br />