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APPLICATi'AN FOR CONSTRUC"ION PERMIT �' <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BASIC: HOL (City No. ?O� ) <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC U __ --- I <br />259-8810 <br />i DEMOUTION I�IxCOM81NATION I l BUILDING I I MECHANICAL i i PLUMBING i i SIC <br />���+��� �� Mnrt nDUNI $5 dTr 21P r�1oNl � <br />SF1;R�T HOMF.S. INC. 237 ELM ST EVERETT. WA 98203 258-1503 <br />II.NANT MRtL�DDRE55 qTY pIP VNONE <br />nHCH1iECiOROESIGNER M\nADDRE55 CITY ZIP P110NE <br />�ifNERnLGONiF�CiOR MIIK�DDRE55 CITY ZIP P110NL SIqLl1GlN1[� <br />SELECT HOMES. INC. 237 ELb1 ST EVERETT, WA 98203 258-150d SELECHI120KN <br />G(CNANILILLCONTR�CTOR MAII�DORESS CITY 21P PNONE SINELIC[NSf� <br />V W MBING GONiR/JtiOq <br />I.ONiR�Ci PqIC[ OF WORK <br />40000 <br />l�ESf.HIBE WORN AND SOUARE FOOT�GE 1NVOlVE� <br />nnoMJSED us[ OF PW lolNf: <br />GITY 21P PIION[ <br />i I G�l OES{juPIH4! OF PI1WENtY (SNO'NN BELOW (M �TT�LM 7W0 CAPIES) <br />Hanabrook Div 3 <br />iu�—.. — mxK oF <br />�'nACEI T11%I D NUMBER <br />��MSiNUCiqNIO�NIEN�ER,A0DNE55.TE <br />PROJECT ADDRESS � <br />IIJ�� % - � � <br />PLUMBING <br />NO. TYPE OF fll(TUNE <br />Z WATER CLOSET (TOILET) <br />BATHTUB <br />2 LAVATORV (WASH BASIN) <br />SHOWER <br />1 KITCHEN SINK 8 DISP <br />IAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOH DRI11N <br />BACKFLOW PREVENTERS <br />POOf DRAINS-RAINLEAC <br />SINK (SERVICE-BAR. ET( <br />SUBTOTAI E <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />INONi5E1MC�� � Re�nse� � <br />GV <br />USF 20vNE 7� lOT ARE� <br />r�`�" I ���I <br />IrM ol LONS7 NOAF STORIES <br />t(33 sf t <br />�Sa sF G <br />OCCUPANGYIORD <br />_ •• Q <br />nl �SON <br />� <br />INI�KL UY <br />FIflE SPRINNI[RS REOD <br />�iNE RUPM R[00 <br />J <br />nniei i <br />❑ NO <br />tio aow`uncunn <br />B�SEMENT � � <br />f.l YES C9'NO <br />HEqNi LIMITATpN <br />%Q / <br />CITY OF EVEREiT <br />LOCALSALES <br />TAX CODE IS 3105 <br />CONT�GT PEHSON ANO PHONE NO <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMiNED T. <br />APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRFI:T <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO C. <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF � <br />OTHER $TATE OR LOCAL LAW REGULATING COtISTRUCTION OR - <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTH(�RIZED BV i <br />OWNER OF THIS PRC�PERTV TO PERFORM THE WORK FOR W4 <br />APPLICATION IS MADE AND I COMPLY WITH T4E STF <br />CONTRACTORS LAW 1g.27 RCW AND 295200 WAC. <br />Sele ilon _s, INc. <br />�v�7—��I <br />:�; �� �.�� <br />CIIYPUSMIFSSIK[Ny NO <br />MECHANICAL <br />N0. TVPE OF E�UIPMENT FEE <br />A/C-NHNDLG UNITS-H.P. T-- <br />�B.T.U. M E.A. <br />M <br />cw i nt� unrtns <br />VENTILATION FAN 1— <br />RANGE HCOD --T- <br />WATER HEATER � <br />WOOD STOVE <br />----- - -- --' -- <br />METAL fIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT <br />P______ . _ .___ .. <br />� ----- ---- - <br />FA�� <br />SUB TOTAL $ <br />�EfiA11T S <br />TOTAL FEE S <br />rcE �+ec[mtra <br />_ .�o ,Q �no� <br />BUILDING 5$, 53S --ffr,r.� <br />��--�.� <br />PLUMBING �/l '' <br />MECMANICAL �j�J �_ <br />ADDITIONAL PLAN CHECK — <br />OTHER __ _ __�Q ; <br />STA7E BUILDING SURCHARGE � J �) <br />�� i <br />PUBLICWORKS 2C%; � <br />TOTAL __ � /� L � J � <br />