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� f , �..�.� �' � � a� W t t� � : =. 'N��� #��:.� „ y � i � <br /> �2� t � q ° ��`}� . '�_.. -1 ei y-iT 7"' � :,.-'X-" }sA21 � �� <br /> � �l .�� ' ��.' "✓i.xi. " � -� <br />� . �- . � � _ . . �_. �'�, ,� <br /> 1.. ° . . . ....,�—'tiu:�..�,_:ww:=_ .. <br /> i ,ni� <br /> ' _ <br /> ,APRlICAT'10::' �OR C(JNISTRUCT���N PERMIT � <br /> TO BE CONIPLETED IN BLACK INK—PLEASE PRINT '�T <br /> HEATING SYSTEM: C]GAS O ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I I DEMOLITIOPI I I COMBfNATION I I BUILUING 'I trcCHANICAL l 1 PLUMBIR'G I ! SIGN <br /> ONMER �AARADDREgS CIiY 21M PHONE ' <br /> "��r1���n'rrp �Uq`i P6����1�SU�(C�ei�r�` 11 rl�,H�1 ���/� (!.,/� )�/ <br /> TE�gry7 MAILADDRE55 C�TY 21P PNONE <br /> ARLHITEGTORDESIGNEB MAILAODPE55 CIiY 21P PHONE <br /> GENERALCONTP�CTOR IAAILADPFE55 QIY ZIP �'HONE STATELICENSE! <br /> IAEGH�MC�LCONTRAGTOO MAILADDRESS ��1Y 21P PHONE STATELICENSEI <br /> PLUA191NOCONTPACTOR MAILAD00E55 CRY ZIP �HONE SiATEIICENSE� -� <br /> CLn55 OF YlORK �� <br /> ��. I N_W I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVFJFRPL INSERT I I BUILDING RELOCATION ��,;. <br /> --- CONT�Ci PERSON AND PIIONE N0. �''��" <br /> �COHTRACT PPICE OF WORN - <br /> DCSCRIOE YlOPK 6ND SOUM[FOOT�GE INVOLVEO <br /> , SfL 1 ���� <br /> PqOPO5EDl15E0FBUILOING i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> �ecn�oescmrrioNOFenoree�v�suowNn[�owonnrrncurouncories� PROVISIONSOf-LAWSANDOR�INANCESGOVERNIIJGTHISTVPEOf <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OFl <br /> ior e�ak oF NOT. THE GRANT:NG OF A PERMIT DOES NOT PRESi�ME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ���^C �/ //'/�L� � • OTHER STATE OR LOC�L LAW REGULATING CONSTRUCTION OF THE <br /> 1 �� PERFO(iMANCE OF CUNSTRUC710N.THAT I AM AUTHORIZED BY THE <br /> , �� OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW 16.27 RCW AN 296.200 WAC. <br /> _ // <br /> 9j � b-U--�1—f , ���it ���07�'� �_. <br /> SiGNF1U11E � OAtE y�p <br /> . P" T A�ORE55 F.ry, <br /> cnrnuswessucer uro. �� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE Y� <br /> WATER CLOSET(TOILEI) � NC—NHNDIG UNITS—H.P. _.�_ <br /> �ATHTUB T_ FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � UNIT HEATEFS—B.T.U. M _ � � <br /> SHOWER ' CLOTHES DRYEFS � P� <br /> KI7CHEN SINK&DISP � VENTILP.TION FAN __T_ <br /> DISHWASHER � RANGE HOOD ' <br /> -- � WATER HEATER � <br /> LAUNDRYTRAY <br /> CLOTF:�S WASHER � WOOD STOVE � � <br /> UAINAL ' METAL FIREPIACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACEINSERT � <br /> FLOCR DRAIN HE�T PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> i ' <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � — --� <br /> _ <br /> — � <br /> � <br /> � <br /> � --T— <br /> — — � <br /> � <br /> � SUB TOTAL $ '� <br /> SUBTOTAL $ � PERMIT $ � <br /> PEAMIT $ � � <br /> — TOTAL FEE $ ' TOTAL FEE $ ' -� <br /> FOR OFFICE USE ONLY: �``'� <br /> FBOIIT SET��CH REM SE7B4CK SIDE SETBAGK PLAN CHECN NU6�OER FEE �ECEIPT NO. j�.�-",., <br /> _ C <br /> {. _, <br /> USE20NE �ornnen VACANi511E PEES VALUATION FEE "� ' <br /> � <br /> BUILOING '`_ <br /> I1PEO�CONiS.ALLOYlAOLE iYPEO�GOHS(ACIUAL occurwcv u0 OravcLnGuunS � <br /> i <br /> �^01P ' PLUM�ING � <br /> 7 � <br /> SRE OF OLDO. NO.OF STOf11E5 PASEIAENT MECHANICAL � � <br /> i <br /> I <br /> OCCUPANCY LO�D Flf E SPRNKlERS REO'D NEIGH7 UMITNION ADDITIONAL PLI�N CHECK � <br /> I �q� <br /> SPRINKLER i <br /> ❑[ASON FOR SPRINNLERS <br /> STATE BUILDING SUFCFIARGE � �,.,. <br /> ' i <br /> I!liPFG OY PL4NSAPFROVEG BV CITY OF[VERETT PU�LIC WORKS i �� <br /> LOCAL SALES � <br /> �� TItX Clii'� IS 3105 Torni_ � ..�. <br /> ___ . ---- <br /> _ �. <br />� � y. .. . . .,a�v . - ^ . .'4 <br /> K <br />�+ �b ' � u ,. .,v � .� i .:- . . .v . __ . ; �. <br />_ �..iF�.N. �AF4's. 'LLr.. +�f � .�� � <br />