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APPLICAT10�1 F�DR COk51"RUGTION PERMIT <br /> , <br /> 6ASIG IIOLLY �'/ � � ��vrrrn <br /> nr rm,a,M�n �_� /_�/C / C c' <br /> �,,�o. �� ,�� e <br /> evFrett � <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> DEMOLITION ' 1 COMBINATION � 1 BUILDING ❑MECHANICAL PLUMBING I 1 SIGN <br /> '�WHI(1 M�II PODI1F55 Cltt IIP PI NE <br /> :>':LIiC9' IIOMi:S, INC. 237 ELM STRBET, EVERL��T, {4P. 98203 �06-:.58-1503 <br /> iCN�Ni MMLADDRlG� CITY 21P PNpNE <br /> ARCH�IFCIq10EFIGNEII MulA0DRE55 CT' Z�P PNONE <br /> GENE�U CONiRACTOR M�I��ODRE55 CRY ZIP FNONE UCENS[� <br /> H n H SELECT ISOMES, INC. 237 ELM STREET, EVERGTT, WA 96203 z06 258-1503 SELECHI110I:�: <br /> � �KJ M[CIUNIGICONiMCiDR MML�D�NE55 C�TY Z�P PNONE UCE�RE• <br /> H <br /> [ H fIUYB�NGCONTpACTOR u�iL�U0NE55 CRV � ZIP PHpNf LICENSEI <br /> � HCn <br /> ci nssor w�nK <br /> � � jt'}(JEW � � ADDITION I I ALTERATION [_l RE7AIR ❑ DEMOLI110N ❑ WOODSTOVE/FRPL INSERT ( I BUILDING RELOCAT10�� <br /> y � 1fN�NiIMPROYEMENiOR14iERqRf1EMO0ELONlV CdITApiF'EREOH�NOPNpNF.NO <br /> � 1-�i� GONi1UCTPRIfEOiWORR: � Y CLARK 258-1503 <br /> y H p�5f,010[WORK GNp 50W�E FOpi�OE INVOLVE� � <br /> �O� CONSTRUCITON OI' SINGLE FAMILY Dl4ELLING GARY KLICK �]9-0555 <br /> y b rnoroseouseocnunon+c 1 HEREB� CER7IFY THAT I HAVE READ AND EXAMWED THIS <br /> C SINGLE FI�h1ILY RGSIDENCE APPLICATION AND KNOW THE SAME TO BE 7RUE AND CORRECT AI.I <br /> HC�+1 p �[ce�nescnirnowovvnoPenrvis�owr+oe�awoneneeHvouneovie�'1 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPF 0� <br /> ,n� n � ' WORK WILL BE COMPIETED WITH WHE7NER SPECIFIED HEREIN C�� <br /> H ior� oiocK a NM. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVi <br /> x y� � -7 AUTHORITV TO VIOLATE OF CANC[L THE PROVISIONS OF �NV <br /> -�i _ � OTHEF STATE OR LOCAL LAW REGULO.I ING CONSTRUCTION OR TFn <br /> H y � r ��bERFORMANCE OF CONSTRUCTION.�;HAi I AM AUTHORIZED BV TNI <br /> gy OWNER OF iHIS PROPERTV TO PERFORM 7HE WORK FOR WHICH <br /> H <br /> n rj y APPLICATION IS MAOE AND I COMPLY WI7H THE STATF <br /> C,�.'C r � n J/ � , �' CONTRACTORS LA'N 1827 RCW AND 296200 W�C. <br /> �� C�7� � SqN�1UpEOFCd1iR�.'TORO��UiHO�IZE��GCNI p>l[ <br /> i <br /> HO[yi� r <br /> rnw[cr�oonEs/ys] L //� X �'r`��`� �-[�'�N� -- <br /> � O� �SGrII �PPIiC�MSCITYBUSiNESIILEN5EN0�NODUSINESSNRAI[ <br /> PLUGBING MECHIINICAL <br /> j NO. TYPE OF FIXTURE OR fTEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � Z WA7ER CLOSET(TOILET) NCrA41NDLG UNITS—H P. _ <br /> �=' z BATHTUB FOFCED AIR SYSTEMS—B.T.U. M E.A. <br /> 2 LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRVERS <br /> 1 KITCNEN SINK d DISP ; VENTILATION FAN <br /> I ���! 1 DISHWASHER i RANGEHOOD <br /> _� LAUNORV TRAY � WATER HEATER <br /> 1 CLOTHES WASHER � WOJD STOVE _ <br /> URINAL METAL FIREPLACE 6 CHIMNEY <br /> �1� DRINKING FOUNTAIN i FIREPUCE INSERT <br /> ' FLOOR DRAIN ' HEA7 PUMP <br /> BACKFLOW?F7EVENTFAS i GRS PIPING <br /> qpOF DRRINS—RAINLEADERS E%H�UST F�N <br /> f=1=1 SINK�SERVICE—BAF,ETC.) . <br /> � I `i'�i <br /> � <br /> ��1 � SUBTOTAL S 1 SUB107AL E <br /> PEAMIT E � PERMIT � <br /> TOTAI FEE E ' TOTAI FEE S <br /> rniMtS[lO�GK � �[�RS[TO�CN / SIDESETB�CS� �Pl�jl ECKNVWEP FEE � AECEICTNO / <br /> S �c1� � �� JC�� .��C%30�% <br /> use a LOT�RE� vecu+r srte FEES VALUATION FEE <br /> —Z' ❑ ves o rro ���o�rm $� 53� �'1•"i � �^�, <br /> IvrlOicoxSt�llOWl.BI[ n'MO�CONSI�t u �^� �Q����� <br /> �_�l( - �� � PLUA191N� �y�.�J� C�-� <br /> sIr oF BIDG NO oF SToa�ES BwSEMEMT �pHANICAI �[' ��2.% <br /> �i ;3tlsf tG.0 / G vEs C9�N0 � . <br /> pCGu�eNGY IOAD FIRE SPRNNLERS��REQD NEqNT L/JIMITATION �ER ��(y�. ���U <br /> � ,a I I YES i'�f NO C� / STATEBURD�NC3SURCH�RGE If�L� <br /> NE�SON fOR SPPINNI[HS <br /> STATE ENEROV SUnCHARGE <br /> nrv�K�iroN�cc ev �ti�r+s�oanovcoov CITY OFEVEREIT ruBUCwoaKs . �(" � �1��� <br /> J�{ LOC11L SIILES � � _ - <br /> y./�j'q) TIU(CO�EIS310S �TAI ir <br />