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�.1" :■.� <br />, AP�LICATIC�1 F�R� CON�'�RUCT'��Id P�FiMIT ��" <br />��,�I (-r� ( f�_Ct TO BE COMPLETED !N BLACK IIJK—PLEASE PFINT <br />�erm�E ��' ��I�►-S�� -- - <br />BUILDING DEPARTMENT HEATING SVSTFM: J GAS �I E EL CTRIC IJ � <br />259 8810 �"� <br />i DEMOLITION I I COMBINATION BUILDING X MECHANICAL ! PLUMBING f_l SIGN <br />OWIlER IANLAD�R"SS CIiY Z�� �HOtIC <br />�DbCf} °�`�I�C �t�z ��7Eh �V�:�E �v r �d.Qii_— <br />T[NANT AIAILAD�RESS CITI' ZIP PNON[ <br />�!`ti,�rrr� ��► F;vtrqr�cn �Uv Fverr�-�- ��203 roh S�� 5�3 r3�-r.� <br />A'iCHITECTUR7E51GNER hInIL40DRES5 CIiY ZI� PHOt1E <br />G[t:C:RFL COMRACTOR <br />CONTRACTOFi <br />ISAIL AD�RESS <br />h1qIL �DORESS <br />CONTPACT PpICE OF WORN <br />� ,� D , UDc <br />�ESCRI6E YlORK AND SOUARE FOOTAGE INVOLVEG <br />urv ziv <br />i. �1l� <br />CITV ZIP <br />u nn�.UODCi q <br />CITV Z�F <br />�i-o��u '�IYIF Cu (!2S_.Qn ��� �I ��r ��r)� <br />PFOPQ:'ED U' : OF pWLUING <br />LCG�L OE°.SCRIPiION OF PROPERTV �540WN �EI OW JR �TTACH i1Y0 COPIES� <br />L07 BLO:K O� <br />��rr� � an SE a SLU��- o F s�c�-� on <br />c�r� ��;n � Q :z-R ��aYlGI�J <br />PT RCEL TAY. I O. IIUTABEF <br />COtlSTRUCT:ONLOANLENDER.ADDRESS,tELEPNONE NOM9ER <br />PROJECTADDRESS� � ��p,� <br />r 1��� i �� ' /�^�-- <br />PLUMBING ^ <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />VlATER CLOSET (TOILET) _ <br />BATHTUB <br />LAVATORY (WASH BASII I) <br />SH�WER <br />KITCHEN SINK 8 DISP <br />DISHWASHER _ <br />LAUNDRYTRAV <br />CLOTHES WASIIER <br />URINAL <br />DRINKING FOUN �AIN <br />FLOOR DRAIN <br />BACKFLOW PFlEVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SItJK (SEHVICG BAR, ETC.) <br />� <br />0 <br />PhONE ^STATE rLICEtISE v <br />'iLLiL�C�� /I � 1�.�� <br />PHOIIE STATELIGENSEa <br />���I.l Q�� tL �L1 - 700� <br />PHONE SIPTELiCENSEn <br />CONTAGT PGRSON AN7 PHONE NO <br />I HERF3Y CEflTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLIGATION AND KNOW THE SAME TO BE TRUE AI:D CORF�CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNI�G THIS ll'�E OF <br />N'OflK bVILL BE COMPLETED WIT'+ WHETHER SPcCIFIED HEREII I OR <br />NOT. THE GiiANTING OF A PERM� I uOFS NOT PFESUME TO GIVE <br />AUTkIOPITY TO VIOIATE OR C,iNCEL fHE PROVISIONS OF .aNY <br />OTHER STATE OR LOCAL LAW !�EGULATING CONSTRUCTION OR iHE <br />PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHI;H <br />APPLICATION IS MADE AND I COIdPLY WITH THE STA'�E <br />GONTRACTORS LAW 78.27 M��: ANG?96200 WAC. <br />CifY0J51NE55LiLEILC rvp <br />MECHANICAL <br />Np, TYPE OF EOUIPMENT <br />� NC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNII riEATERS—B.T.U. M <br />Cl'1THES DRYERS <br />V[NTILATION FAN <br />RA�GEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BUR <br />FIREPLACE INSERT <br />HEAT PUMP <br />j GAS PIPING <br />EXHAUSTFAN <br />� SUB TOTAL S I <br />PEFMIT 5 <br />� TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRJNiScTE?�r�,( REARSETBACN SIOESET�4CK P��N <br />USJ: <br />iYl9 f I <br />SIIG 7F PLOG <br />OCCUP�NLYL0�0 <br />REA50�' <br />LOT AREA <br />FIRE SPR�NKLERS FEQ'D <br />FIFE A�AR61 FiEO � <br />p�' I p�pN51PPROVEDOV <br />JFTE\� Y�/�/��i <br />VACANT SITE YCCS <br />-�: YES -� NO BUILDING <br />C.C�I';I;Cv YO O�O:VEIlP:G1iNi15 <br />c�ouv PLUMBING <br />BASEMEHT 1dECHANICAL <br />' YES C NO <br />HEIGHT uM1tltnTlO�! �DDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILOING SURCHARGE <br />CITI' OF [VERETT PUBLIC WORKs <br />LOCAL SALES <br />TAX COOE IS 3105 rorn� <br />FEE <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />a'-,�9 - <br />i <br />0 <br />a-O ' Or� <br />/� i0� <br />�� �DU <br />no <br />N <br />N <br />�p <br />M <br />�X <br />O <br />♦ <br />