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APPLICAT`�N FOR CONSTRUC�'ION PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> ) <br /> BUILDING DEPARTMENT HEA7ING SYSTEM: Q GAS ❑ELECTRIC O <br /> 259-8810 <br /> ' I DEMOLITION p0 COMBINATION ❑ BUILDIN(i ❑MECHANICAL C I PLUMBING LI SI� <br /> OMMER M�ILAODRE55 CITY 21P PNONE <br /> SELECT HOMES, INC. 237 ELM ST EVERETT 98203 258-1503 <br /> iENNlT MALMORE55 CffY 2q VHONE <br /> •HCHITEGTOqDE51GNER /MILI/'OPE55 CITY 21P PHONE <br /> GENEF/�LGONTRIICTOR M�0.ADDRESS CITY 21P PIIONE ST�TELICENSEI <br /> SELECT HOMES� INC. 237 ELM ST EVERETT 98203 258-1503 SELECHI110KN <br /> MCCNM11GlCONTR/iCT0f1 W11L�WRESS CITY ZIP PIqHE Si11TElIGENSE� <br /> PlUMOMOCdITR11LTOR WtADDf1ESS GITY ZIP PIIONE ST�fELICENSEI <br /> CplTRACT%IICE OF NIOIM � <br /> 40000 <br /> DESCPIBE NORK IJlD SOU�NE FOOiWE INVOLVED ' (`qNfACi FE11Sd1 NID RIONE Iq. <br /> SFR Rand Clark 258-1503 <br /> I HEREBV CERTIFY THAT 1 HAVE REAO AND EXAMINED T <br /> PROPOSE�USE OF&MDM6 APPLICATION AND KNO�"/THE SAME TO BE TRUE AND CORRECT. <br /> c�n PROVISIONS OF LAWS AND OFiDINANCES GOVERNING THIS TYPE <br /> IkCJLLDESGR{PTYMlf)F PROPERTY�SIqWNlELOWORATTACMIYNCOPIEB� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN <br /> ior 3 � e�ocK pp HANABROOK DIV` '�I �NOL THE GflANTING OF A PERMIT DOES NOT PRESUME TO C <br /> � AUTHOHITY TO VIOIATE OR CANCEL THE PHOVISIONS OF � <br /> . OTHER STATE OR LOCAL UW REGULATING CONSTRUCTION OR- <br /> 3�/G � � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WH <br /> APPL�CATION IS MADE AND I COMPLY WITH THE ST. <br /> P�qCEI TA7l ID.NUMBER (�`�.JLE C7pps �B. )pG`YILAND 296200 WAC. <br /> SE CT A s iiac; <br /> LONSTPIIC LMHLENDER.MMIESS.IElEP110NE NUYBER <br /> .�d -I.�OD �_ "! 5/ <br /> PROJECT A E �*�^E ^�'� <br /> S � � <br /> cmen�c�ict�scro <br /> pLUMSNq MECHANICAL <br /> NO. TYPE OF Fl)ITURE OR REM FEE N0. NPE OF EOUIPMENT FEE <br /> 3 WATEH CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. � <br /> BATHTUB ' 1 FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> 3 LAVATORV(M/ASH BASIN) � • � UNIT HEATERS--B.LU. M <br /> SHOWER � 1 CLOTNES DRYERS <br /> 1 Y.ITCHEN SINK 8 DISP i VENTILATION FAN ' <br /> 1 DISHWASHER � 1 RANGE FIOOD � <br /> UUNDRY TRAY ; 1 WATER HEATER <br /> 1 CLOTHES WASHER � � WOOD STOVE � <br /> —� <br /> URINAI ' METAL FIREPUICE(WOOD BURNING) <br /> DRINKINC FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN ' � HEAT PUMP � <br /> BACKKLOW PREVENTERS i GI�S PIPING <br /> ROOFDRAINS--RAIMIEADERS � E%HAUSTFAN <br /> SINK(SERVICE—BAR,ETC.) ' <br /> � <br /> , <br /> � <br /> � <br /> SUB TOTAL f i SUB TOTAL S i� <br /> PERMIT I � PERMIT f � <br /> TOTALFEE S ' TOTALFEE f ' <br /> FOR OFFlI.E USE ONLY: / S �- �^ <br /> FHONT SETB�CIfO J REM SE7B�CIl / S�DE SE1MCIf_ / %NI p1E �� FEE ^� "�9 9 y/o <br /> 2 � � <br /> useza� �oru�� v�c�wrs�re FEES VAWATON FEE <br /> �P.�' ,� ❑ VES ❑ NO BUiLDxx3 — <br /> .rrc a caac No.av sra+�s aa,w+n� �o vo.nuowm �^ — — <br /> _ � Z PLUMaINO i'" <br /> SREp�e�oq FIRESPRRMIEflSPEO'D B�SEMFMT —/ MECH�NICAL � <br /> ��fY) S P i' �J ❑ YES I4TN0 _ <br /> —S <br /> ocCuvuiCrtOW FIREIIUIRMIIEO'D HEqNiuMii�� ADDITIONALPLANCHECN � ; � <br /> p O Z OTHER (� �� ��J ;_ <br /> RE�SON T <br /> STATE BUILDING SURCHARGE / `�Q <br /> INIANE BV PUlIS APPROVED BY CITY OF EYEHEIT PUBUC WORKS � <br /> �J la LOCAL SIILES , <br /> o�T� 3 /� 9 TIU(CODE 18 3105 TOTAL � � ;� <br />