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APPLICATIQ�; FOR CONSTRUCT: )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: � GAS J ELECTRIC ❑ --1 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> f-7 DEMOLITION l: COMBINATION i I BUILDING �ECHANICAL I_l PLUMBING i_1 SIGN <br /> OWNER IdMLApDP[SS CIiY ZiP PHONE <br /> �crN �� ev�c°N �„�, mermo�+ ��,e��++ � ���3 a�a-��a <br /> tENA�— MAILA�DRESS CIN 21P PHONE <br /> ARCHRECTOR�ESIGNER MAILADORE55 CITV 21P PHONE <br /> GENERAL CONfflACTOR MFIL 4�ORESS CITV ZIP PNOYi' STATE UCENSE M <br /> 1.1ECMANICALWNTRFCTOR MAILA�DRE55 GITV 21P PMONE STqTEUCENSEd <br /> .�d icu� 1lPahn �2o es+n � �er w Zo s3-3��=1--���1 �� a 49 0 �- <br /> PLUMBINGCONTRACTOR MAILAD�PE55 GTV ZIP Ph.NE STATELICENSEe <br /> CONTR�CT PRILE OF WORK <br /> �D -- <br /> DESCHIBE WORK AND SOUARE FOOi�G[�NVOLVEO CONTnCT PERSON A�+O PHONE NO. <br /> i HEREBY CERTI� � THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUS oFeuuoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LF.GFLDESCRIPi10NOFP OPERTY�SHOWNBELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NUT. THE GRi.:ITING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWN[R OF THIS PR PERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS ADE AND I COMPLY WITH TfiE STATE <br /> rnacei Tnx i.o.Nuuaea CONTRACTOFS LA 18.27 RCW AND 29G200 WAC. <br /> CONSTRUCTIONLOANLENDER.ADOPESS.TEIEPHONENUMBER <br /> � �.1. H. <br /> PROJECT DRESS s�c�niunc --n<ic <br /> ��' cirr eusiu�ss uccrn=r�o <br /> PLUMBING MEC:IANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AiC—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSI'EMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDFYERS <br /> KITCHEN SINK 8 DISP VEhTILATION�AN ' <br /> -T <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL i METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> --� <br /> BACKFLOW PR[VENTERS GAS PIPIYG <br /> ROOF DRAINS—RAINLEADERS --?— EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) ; _ _ <br /> � <br /> � T_ <br /> SUBTOTAL 3 SUBTOTAL 5 <br /> PER!v11T 5 PERMIT S <br /> TOTAL FEE 5 TOTAL FEE 5 —�— <br /> FOR OFFICE USE ONLY: <br /> - FRONi5ETB4CX REARSET�ACK SIpES@TBACK PLA'lGHECI(t1UM/pE/R> FE[ NECEIPTNO <br /> � �/�-/V <br /> usezor+e �ornaen VFCANTSITE FEES VALUATION FEE <br /> �� VE� �'� NO BUILDING � <br /> iYf'EOiCON57. NOAFSTORIEb octuaarvr M1oorphEwr,�cvny — — — i � <br /> �aWP PWM�ING <br /> —i— <br /> Si]EOFOLOG. FlRESPRINY.LERSREG'D DASEMENT NECHANICAL <br /> �] YES �.- NO -- <br /> OCCUPANCYlOAD FIREALARMFEOD MEIGNiLIIAITAT10N ADIIITIONALPLANCNECK i <br /> � <br /> OTHEN <br /> R[ASON — ----�— <br /> STATE BUiLDING SURCHARGE � <br /> INIANEOV PLANS��'PROVEDOV CITYOF@VERETT PUBUGWOFKS <br /> LOCAL SALES <br /> oqTE TAX CODE IS 3105 rorn� <br /> � � <br />