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APPLI�C�ATIQ��' FOR G�NSTRIDCT.'"��PI P�.RN��I7' �✓�� <br />TO BE COMPL�TED IN BLACK INK—PLEASE PRINT <br />HEATW�'� SYSTEM: ❑ GAS 11 ELECTRIC f.J _J <br />BUII.DiNG DEPARTMEN� _ <br />259-bu10 �jr�cl (� <br />I_I�EMOLITION af.1 COMBINATION _' I BUILDING iJ MECI�ANICAL ❑ PLUiNBING ❑ SIGN <br />- — � 7 <br />OWNER MFIL�DDRESS <br />- AG76�� �T L C,9 v/ > <br />TENqNT MNLA��RESS <br />Poi3 3 � 9� � <br />ARCHITECT OR OESIGNEfl MML A�DRESS <br />GEN�A CONTR�CTOR MNILAOORESS <br />�pc,�iC-.yd GA/�LE h�1; <br />MECH�NICA�6DNTFP^.TOR M�ILAODPESS <br />PLUTABINGCONTRACTOR MPILA�DFESS <br />CCNTiiACTPR:C OFR'ORN <br />��`�UO <br />DESCRI3E WORK AND S�UARE FOOTAGE f��9��E1 <br />,�� J, �DUY �G <br />�iir <br />�5-� L �v� <br />CITY <br />��� <br />G�fV <br />,SCS ��/3 <br />CITV <br />CITV <br />\�PRr�ffi��a����o% �/•� G�//�.�� <br />' LEGAL �ESCRIPTION OF PROPEFTV (SHOWN BEIOW OR ATTSG4 RVO <br />/5 � D–O� ��t'✓ � <br />LOT HLOGK OF <br />PAFCELiA%I.D.NUhiBER 'n/� _ Q 60 Z <br />i� 3g3O - 000 - V <br />CONSTPUCTIONL04NLENDEF.ADDRESS,TELEPHONEhl1M�Efl <br />SO Z <br />OF <br />LAVATORY�WASH tlA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAI� <br />:�� <br />,v.v �'P�M�"� <br />ITEM <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBPrK REARSETBNCN <br />. <br />ucr.vnuc LOTAREA <br />IYPE OF CONSi. <br />� <br />SIZL OF BLDG. <br />NA <br />OCCUPANCVLOAD <br />rJ A <br />Ii.T�KE BY <br />NO.OF ST�OqIES <br />FIR �RINKlERS REO'� <br />rJ A <br />FIRE �LARIA REOD <br />�J A <br />PLANSl�PFROVED BY <br />✓J '� <br />DATE � � J - y <br />FEE <br />0 <br />.:iF l/JD[� vHorat 3 .�'8– L/3 � <br />C6'�T/ u��4�J ��/N�PJ�I �v/19�>�T <br />21P � PHONE � <br />� �p� �� rHor+e <br />CONTAGT <br />PNONE STATELICENSEn — � <br />�=���r��� S�'�oy <br />PHONE STATEL��E���EA <br />PHONE STATE LICENSE a <br />3 y8- �°/3 <br />i HEREfiY CtRTIFY THAT I FIAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS ANU ORCINANCES GOVERNING ThIIS TYPE OF <br />WORK 1NILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TtIE GRANTING OF A PERMIT DOES t:OT 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 CONSTflUCTION. THAT I AM AUTHOf�IZED uY THE <br />OWNER OF THIS PROPERTY TO PFR�ORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CUNTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />NO. TYPE OF E�UIPMENT FEE <br />A/C—A�HNDLG UNITS—H.P. <br />FOP.CED AIR SYSTEMS—B.T.U. M E.A. ; <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS ' <br />VEP:TILATION FAN � <br />RANGEHOOD _ <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) _ <br />FIREPLACE INSERT _ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN . <br />SIDE SET�ACK PLAN GNECK NU! (3ER FEE <br />I '7 <br />O L <br />VACANT SITE FEES <br />C; YES �NO yUILDING <br />Ottucapc tA.ovDMlEIIiNGU4i15 <br />�aouv PW6IBING <br />BnSE�AENT MECHANICAL <br />�=1 YES i7 NO <br />MEIGHT LIMITATION A�DITIONAL PLAN CHECK <br />� I OTHER <br />STATE BUILDING SUFCHARGE <br />CITY OF � VERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />FEE <br />�� <br />. <br />