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r <br />�- <br />;hcLl'CivOF r �� ����V�i�V��Io�t:�.� f.�..4 <br />evereit PERMIT PERMIT N0. ��026 <br />LI7Y HALL 259�8745 <br />[VERETT, WA 98201 � COMBINATION ❑ BUILDING 0 MECHANICAL ❑ PLUMBING <br />❑ NEW ❑ AD�ITION � ALTEFATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN ❑ WOOD STOVE/FIREPLACE INSERT <br />VRLtITT10N OF WOfl�Ky �y v <br />S �i (l �ll '' . <br />ATTACH FOUR LOPIES� <br />LOi____OLOCK_OF <br />JOB ADDRE55 <br />��f02 �� � � ..�.c��.,C <br />PLUMBING <br />TYFE OF FIXTURE OR ITEM <br />WATER GLOSET (TOILEn <br />BATHTUB <br />SHOWER <br />KITCHEN SINK d DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />ORINKING fOUNTAIN <br />FLOOR DRAIN <br />VACUUM BREAKEFS <br />ROOF DRAINS - RAINLEADERS <br />SINK (SERVICE - BAR, ETC.) <br />SIIB TOTAL <br />PERMIT <br />TOTAL FEE <br />TYPG OF CONSL p <br />SIZE OF BLOG. �h <br />1. ENVIRONMENTAL CHECK LIS7 <br />Z. BUILDING PLANS <br />3. FIRE HYDRANT <br />n. FIRE P00TECTION SVSTEM <br />5. GRADING <br />6. DR 11NAGF. <br />7.ENVIRONMENTALIMPACTSTATEMENT <br />8. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHE� <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br />APPI iCATION AND KNOW THE SAME TO BE TRUE AND <br />CORHL"CT. ALL PROV�SIONS OF LAWS AND ORDINAN('ES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HERE!N OR NOT. THE GRANTING OF A <br />PERMIT DOES NO"i PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFiUCTION. <br />SIGNATUPE O�OjIT��aOR AUTMOfl12E0 AGENT DATE. _ <br />MECHANYCAL <br />PEE N0. P OF EOUIPMENT <br />AIR COND. U S— H.P. EA. <br />REFRIGERATI N UNITS — H.P, EA. <br />BOI�ERS — H.P. EA. <br />GAS FIRED �.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALL HEATERS — B.T.U, M <br />UNIT HEA7E�iS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRVERS <br />_ VENTILATION FAN <br />RANGEHOOD <br />AI7 HANOLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACEINSER7 <br />HEAT PUMP <br />' I � I I SU9 TOTAL 5 <br />SI I I _I PERMIT 5 <br />5 TO7AL FEE 5 <br />EAfl VAflD SETBACK PLAN CHECN Nl1M6Efl � PLAN CI <br />VACANT SirE <br />:;YES ��.-NO <br />FEE � RECEIPT NO. <br />VALUATION I FEE <br />BUILDING S '-:� <br />IdAX. OCQ LOAD <br />PLUMBING <br />FIRE SPRINKLERS MECHANICAL <br />REOUIRED <br />-iYES ❑NO <br />BY OATE OTHER <br />PENALTY U.B.C. <br />SEC.3�3�a) j,.(�. b <br />TOTA� � 6� - <br />PEHMIT VALIDATION <br />INHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOU(i PERMIT �Q <br />�' <? ;;,;32.�0 - �1�+ <br />� <br />V <br />4PPR.fORISSUANCE BV � - � � � `�' <br />i l" � <br />U <br />ADDRESS FILE ' `"� ` ' <br />� <br />� <br />Kp <br />• <br />� <br />� <br />