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APPLICATION FOR CONSTRUCTk.N PERMIT " <br />theEM191M,,, TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />eve Nett HEATING SYSTEM: GAS J ELECTRIC ❑ _ _- <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL f_i PLUMBING SIGN <br />f \_OVMER MAIL ADDRESS CITY IIP PHONE <br />,T sc-c cf .=L <br />�TENANT MAR ADDRESS CITY 21P PHONE <br />n.wnn w,vn vcomncn <br />�Y rnmc wvncao <br />(\MAIL <br />cm <br />ZIP <br />PHONE <br />\GENERAL CONTRACTOR <br />ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />-T <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE I <br />_ASS OF WORK - - -- <br />1 NEW ' ADDITION I l ALTERATION REPAIR DEMOLITION WOODSTOVFYFRPI INRFRT All III nlNn on n ATlnM <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />z SeU O <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />r <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPE SHOWN BELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 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 />CONTRACTORS LAW 10.27 RCAF AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />L — <br />PROJECTAD75S <br />APPLICANTS CITY BUSINESS IICEIPA NO AND BUSINESS NAME <br />C_ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A(HNDLG UNITS—H.P. <br />, <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />, <br />LAVATORY (WASH BASIN) <br />, <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />;HSHWASHER <br />RANGE HOOD <br />, <br />TRAY <br />; <br />WATER HEATER <br />_IAUNDRV <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />; <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />�— <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />, <br />SINK (SERVICE —BAR, ETC.) <br />' <br />1 <br />I <br />I <br />, <br />1 <br />I <br />� <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT E <br />I <br />PERMIT $ <br />TOTAL FEE E <br />' <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />111 <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />i <br />i <br />TYPE OF CONIS AGOWASIf <br />TYN OF CONS) ACIUAI <br />nc[uw.Nn <br />c+ae <br />NnuPMUWG UNiR <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL��— <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D <br />REASON FOR SPFINKLEPS <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF IVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />