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APPLICATIC�1 FOR CONSTRUCT'1N PERMaT � <br />TO BF COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: J GAS J ELECTFIC �d �ON (i <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOUTION � I COMBINATION j� BUILDING MECHANICAL ' I PLUMBING I SIGN <br />OWNER IAAIIADDRESS CItY 21P PMONE <br />..Sol� berSf �.I1L S+�,f• .S� ��n;R�tr ySr{oi ZS9 -175'S _ <br />TENANT ^ M MAILAOORESS CITV ZiP PHONE <br />�R/ •�� <br />4RGHIiECTORDE5IGNEB MAiLADDRE55 CITY ZiP PNONE <br />SR/`tC- <br />GENEfiAL GONTqACTOR IAAIL ADDRE55 Q7V ZiP � PHONE STATE UGENSE � <br />MECHAN�IC L CONiflACTOR IAAIL AO�RE55 CRY 21P PNONE STAT2 LICENSE • <br />PWhIB�NGC�M1'TRAC70R MAILA�DR[SS CITV 21P PHONf STATEUCENSE/ <br />CONTFACT PRICE OF \VORH <br />G 7�(� -- /O 7� <br />0[SCRIOE WORN ANJ SOUARE FOOTAGE INVOLVED <br />GONTACT PERSON AND PHpNE N0. IO� N <br />•J <br />(,71, .s�� Dc tc'�e� �c.r��,e ��'"��- LSq�l��s" uart 3'1.t-�io�. <br />PROPOSED)!SE"OFOUILDMG <br />_ l,/iKA( L <br />LEGRL �ESCRIPTION OF PROPERiY ISHOWN 9ELOW OR ATTAGN T.40 WPIE51 <br />.OT BLOCN � OF <br />Fl,RCELTAXIO.NUMBEP <br />�0�405-1-037-00�3 <br />WNSTRUL7IN� NLEN�ER,�DDRESS.TELEPHDN`NUM�ER <br />1' <br />PROJECT A DRESS <br />�.Il(� Stni� Si �v�lkerr �teA <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET �TOILET� <br />BATHTUB <br />I.AVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRA <br />CLOTHES WA: <br />URINAL <br />DRINKING FOl <br />FLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAINS <br />FOR OFFICE USE ONLY: <br />FfiONiS/[1J�A�CN REARS[T CK <br />i�� � Z. Z/ <br />USE20NE LOiAREA <br />v o <br />nrE or carist NO OF STORIES <br />— I � <br />SIZE OF BIOG. FlPE SPRINNLERS REOD <br />FlNE ALARM REO D <br />REASON <br />MtneEBr I PL�NSnPrf�oVfoov <br />ontE <br />0 <br />s <br />S <br />5 <br />SIDE SET�AG� <br />� <br />VACPNT SITE <br />-: vEs �o <br />occ.�cvc. eo rz�owtumcu•�as <br />BASE�A[NT -�/ <br />YES IvNO <br />CITY OF [VERETT <br />LOCAL SRLES <br />TAX CODE IS 3105 <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS APlD ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WI�H WHEtHER SPECIFIED HEREIN OR <br />NOT. THE GHANTING OF A PEFMIT UOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION, THAT I AM AUTHORI2ED BY THE <br />CWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 18.27 RCW AND 296.200 WAC. <br />X �� U9,�,s-- „ a t <br />s�cn+mnc 7 �"�� <br />�,ED AIR SYSTEMS—B.T.U. M E.A. <br />HEATERS—B.T.U. M <br />HES DRYERS <br />ILATION FAN <br />3E HOOD <br />METAL <br />HEAT PUA <br />GAS PIPI� <br />E%HAUST <br />SUB TO <br />PERMIT <br />TOTALF <br />PLANCI�% �nOX I FEE ^/ �D <br />i � <br />FEE <br />BUILOING z / G[/.' ' �'C <br />� <br />PLUMBING <br />�— <br />MECHANICAL <br />ADDITIONAL PLAN CHECN <br />OTHER �_ <br />STATE BUILUING SURCHARGE <br />y <br />PUBLIC WORKS � <br />9T/� <br />TO7AL ���J C� '��� <br />