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APPLICATf+� FOR COtdSYRUCT�N P�RWII'T � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILD!NG DEPARTMENT � HEATING SYSTEAI: �j GAS J ELECTRIC J _ � <br /> 259 881 D <br /> DEPdOU?ION . COMBINATION . BUILDING ' .MECHANICAL '/6 PLUMBING � �. SIGN <br /> , �.uanooaess l civ r�r rnarve <br /> i�tt r��^�r;�r sys q�'" 3¢.tih �� vL�� ���oa �s�r 6s�� — <br /> �.i•;..•.• rd^"aopness arv ria vrMsiE — <br /> N/�F <br /> ni .�:vnno�sm��cn M+nnonness cirv nP v��onc <br /> ST�atir�v Sra�Y �� aAq3 /�r yti�NoN ir� �/9.273 j36 �37/ <br /> _ .. �.�f,orvrMcrUB �A<itaoonESs Glv z�v oNOrIE srAiEl�tExSE� <br /> a w/�h Q <br /> . . � .CnIf,ONiH4CiON M4!L��DFESS Li1Y II� VMONE SLREIIC[NSE� <br /> // <br /> :, . .��CUNif1ALtOf1 IAAILAODPE55 CIiY ZIP FI�OHE S�AiEIICENSE• <br /> I/ <br /> � . i+;1IPPh:E0III0PN <br /> .. nPl l'IOPn�1105W�REfWiAGEINVOlVEO S.nt��� � LONi�CiPEPSpIANUPWNENJ� nT �yL ,, <br /> C /f /� N �� <br /> S_,�1�� � ,�wt�w,�-••.o k�� -/llrqbsl6 tv .�IsF'-dJl4 _ <br /> _ �j�{'�(v( � / .,�� ti (�(�(s'Lr✓Ii. i HEREBV f,ERTIFV THAT I HAVE READ AND EXAMINEU THIS <br /> ��� ��:cnus[orBunoniG � � n APPLIC4TION AN�KNOW THE SAME TO�E TRUE AN�CORREC7 ALL <br /> K PROVISIONS OF LAY/S AND ORDINANCFS GOVERNING THIS TVPE OP <br /> .�..<,r�r..ewv�ror�orveorearv�;�iowneeiowai�nriewrwocw��es� � WORK WILL BE COMPLETED WITH WHETHER SAECIFIE�HEFEIN OR <br /> � /(J�j FI� �((( I;OT.THE GRANTING OP A PERMIT �OES NOT PRESUME TO GIVE <br /> �-��.. - - eimn-- or / �4 qUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �r [`1u1�1��Irq(N•e_(��¢[l u�_ I_�1"�'V Y�Y!.�____ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � - � PEFFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE�BY THE <br /> ( •/4h 3/ � 7Hv�� .J�� 2 �„y � N.�J-� OWIIER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH <br /> d�(S �7 pPPLICATION IS MADE ANO I COMPLY WITH TNE STATC <br /> �.. . �.��o ur.men p � <br /> C01JiRACTORS LAW 18 ]RCW AND 296200 WAC. <br /> i ,,, riio.��n�M1otRn�DFE55�F�fvucNFiu!n!�2�� <br /> N/A � -%-� '� <br /> X--- - -- <br /> PROJECT ADURESS ��'�'� - ""� <br /> 5�5 _ Q7?6 5f" >—,� <br /> PL11M81NG MECMANICAL <br /> NO. TYPEOFFI%TUREORITEM FEE N0. TVPEOFEOUIPMENT FEE <br /> \7ATfR CLOSET ITO!LETI � A C--A HIl�LG UNITS-H P ' <br /> j �1,1iV��UP fOHCEDNRSV5TEM5-6T.U. M E.A. <br /> LqV/QOHv ivlASFi�qSINI UNIT HEATERS-B.TU. Id ' <br /> ^� 91GWER CLOTHESDRYEFS � _ <br /> � HITCHEN SINN&OISP VENTILATION FAN ' <br /> � DISHWASHEF RANGEHOOD � <br /> LAUN�RY TRAY WATER HCATER ' <br /> � GLOTHES WASHER WOO�STOVE ' <br /> URINAL METAL FIREPL4CE�WOOD BURNING� � <br /> f]RINKING FOIJNTAIN FIREPLACE INSEflT ' <br /> FLOOP ORAIN HE�T P11MP � <br /> �ACKFLOIYPRFVENTEflS ' GASPIPING � <br /> HOOF DRAINS-RAINLEADERS E%HAUST PAN � <br /> , SINK�SERVICE-BAR.ETQ� ' <br /> _ SUB TOTAL S $UB TOTAL S ' <br /> PFflMIT S `'= ' PF.RldIT 5 <br /> � � TOT�LPEE 4 /��� TOTFLFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> �.. . .�... . � ..�,.�� ._._.�_.' soes�*oecn � nnmou .m�c/y�{n ra necoanro <br /> � i/.{rl <br /> . . . . � '.cimrt.e vnurv*Si*E FEES VALUATION FEE <br /> - � YES �� NO pVi�oiNG <br /> ... . �:I NO OF StORiES 40 dv�l�',nte.'t <br /> °V'" PLUM1IBING <br /> .. ' .] FIflESPNNKIEPSBEO➢ P�SE1AENi I,IECHANtUL <br /> � ' YES . ' NO - <br /> ...,,_y�p�p FlNE1l�nF�PEOU ME�GNILiN�lR1�ON RDDITIONRIPIANCHECK <br /> OTHEfl <br /> ti�niF FUIi.DiNG eU�iOlaaGE <br /> —__.__.." _ . . . _ . . _-- � — <br /> � �' �`�'��" � �– - � CITYOF[VERETT ,•uuucwoeHs <br /> , LOCALSALES � <br /> ... �. TAX COOE IS 3105 �ora� ' <br />