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APPLICATIGA FOR CONSTRUCTmON PERMIT <br /> CITY OF EE T•BUILDING DIVISION <br /> 3200 CEDAR STREET <br /> A E <br /> ET• VERETT, WA 98201 •259.8810 <br /> I I DEMOLITION I I COMBINATION I I BUILDING I MECHANICAL PLUMBINGSIGN <br /> PROJECT ADDRESS <br /> FR MAIL ADDRESS 1� rtv Tir Ct <br /> rrroNr �IT� <br /> IF IMMI ADTMf 55 CITY )IP PHONE <br /> A11CIll .CT OR OESIONER MAN ADDRESSCITY )IP PIIONF <br /> OENEILALCONHTACIOR MAIL ADDRESS CITY )Ir PHONE <br /> STATE IICEN$E. <br /> MECHANICAL CONTRACTOR MAIL ATNXTF.55 CITY )IP PHONE STATE LICENSE. <br /> LUMBBl <br /> PGCONTR LFI MAILADDRESS CITY ZIP PHONE STATE LICENSE. <br /> CONTFI tPRICEof Wo11K <br /> HEATING SYSTEM: GAS f 1 ELECTRIC rl <br /> DE SCRIRE WORK AND SWARF.FOOTAGE) <br /> DIVED C.ONUCT.78501 DPIIONF.Lon N <br /> –�� um4--►— �(: u nC•m �� - ��1�j <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUBDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL OE SCRIPTION OF PROPE HTV I SHOWN BELOW OR AT TAC II IWO COPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BILx.K or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX ID NUMBER CONTRACTORS LAW 18.27 RCW AND 286.200 WAG. <br /> CONSTRUCTION IOAN LENUEn.ADDRESS,TELEPHONE NUMBER X—` I R1q <br /> 1�1 <br /> SIGNATURE DATE <br /> &Y BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. _TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) ' AID—AAiNDLG UNDS—H.P. r <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) , HEAT PUMP <br /> SHOWER ' UNIT HEATERS—B.T.U. M I <br /> KITCHEN SINK A DISP i CLOTHES DRYERS ' <br /> DISHWASHER r VENTILATION FAN r <br /> LAUNDRY TRAY I RANGE HOOD =BURNING) : <br /> CLOTHES WASHER WATER HEATERURINAL ' WOOD STOVEDRINKING FOUNTAIN METAL FIREPLACE FLOOR DRAIN r FIREPLACE INSERTBACKFLOW PREVENTERS GAS FIREPLACE <br /> SINK(SERVICE—BAR,ETC.) I GAS RANGE , <br /> ' OAS PIPING I <br /> r EXHAUSTFAN , <br /> I � <br /> I � <br /> r <br /> I � <br /> SUB TOTAL S ' SUB TOTAL $ ' <br /> PERMIT S r PERMIT S 1 <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> rRONT SETBACK BEAR SETBACK SIDESETBACK PIANCIIECK 1 n r[F RECEIPT NO <br /> O <br /> )ISE ZONE To AnEA VACANT SITE FEES VALUATION FEE <br /> IIYES f1 NO BUILDING <br /> Hf10H1 LIMITATIW ND OF DWELLING SITE Or IIIXirti <br /> UNITS <br /> PLUMBING <br /> OCC FANCY NOM 51mi 5 LICCIIPANT LOAD BAEN <br /> SEMT MECHANICAL <br /> IIVES 11 NO <br /> 1 <br /> TIRE AIABM BEOn OFASON AOg11M/AI.PAN CHECK � <br /> TIRE srmNKl Fn neoOTHERn afAFON _ <br /> STATE BUR DING sUnCHARRE <br /> TVPFOF CONST PIANS APPROVED RV CITYOFEVERETT PIIBIIrwonkn ' <br /> LOCAL SALES <br /> rAIE TAX CODE IS 3105 TOTAL <br />