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i <br /> APPLICATION FOR GOI'�$1'RU�TIQN P�RMlT <br /> ���•�,��� <br /> �,,,,�,�.,;, � <br /> everett <br /> ❑UILDWG DEPARTMENT TO BE COMPLETED IN INK—PL�ASE PRINT <br /> :59-88t0 XNMECHANICAL XXPLUMBING ! '. SIGN <br /> DEMOUTION I I COMbi;�ATIOIV XX BUILDING -- <br /> -- rnn�ieomi[ss qir nv Y��on[ <br /> :dd h <br /> � � " c�l�rt��omes, in� ?�7 F i'�erett [°A 98203-1921 206 258-1503 <br /> "� 21P PII(NiE <br /> �p Kq ����p��� MALLAODRE55 ��TY <br /> p P � <br /> � y N nnOul[CloilulsK.N[�1 MnKI.U011e55 Ury Z�V vl:'.WE I <br /> K � � / i}\tflGLCONIPALIOfl 1MM1MORC55 CITY z�P PlqftE IICEN5E1 , <br /> O S O � G��prt ❑om�.'. WA 98203-1921. S6LECHI110KN <br /> � y H — I <br /> �+ .4CnnNCN CIX171iACTOR MALL M�PESS CIiY LN PIqryE LKENSE I <br /> C Z' 7. <br /> � � � r�UMOWGCONiMLinp MAK�UDPE55 CIIY ZiP PI�Of1E LICENk1 <br /> O M <br /> z n c <br /> •• �' RH • c �.�nssawonK <br /> b y � kx NEW I I ADDITION I I ALTERATION ❑ REPAIR ❑ DEtdOLIT10N ❑ WOODSTOVE/FRPLINSERT l l �UILDINGRELOCATION <br /> �' N H iUlAN11MPFOVLMINtORIN111110ii11lMWlLOHLY CAN7ACTP[PSOIIMiUP110NE1q. <br /> o N ,.unHecrrruccovwoia: �nd Clflrk 258-1503 oY 348-1320 <br /> M <br /> n � y blSCNO[YN�UM�DSOUMI[f001�GCINYQYE� <br /> � � y �-ucibxnuscaawimno ' - I HEREOY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ti� APPLICATION AND KNOW THF SAIAE TO BE TRUE AND CORRECT.ALL <br /> ,ic,�iuie; �arrwr+ovrno��c VIS��UWNUELOWOHATfACMFOUNC014kY) PflOVISIONSOFLAWSANDORDINANCESGOVEFNING7HIS7YPEOF <br /> �1 � . WORK WILL BE COMPLETED WITH WHE7H[R SPECIFI[D HEREIN OR <br /> ;�� I / oiocn or ' NOT. THE GRAN7lNG OI' A PERMIT DOES NOT PR@SUMG TO GIV[ I <br /> D1V].S10I1 1 ' . AUTHORITY TO VIOLATE OR CAIJCEL THE PROVISIONS Of ANY <br /> OTHEfl STATE OR LOCAL LAW R@GULATING CONSTNUCTION OR THE <br /> - . PERFORMANCE OF CONSTRUCTION.1'HAT I AM AUTHORIZEO UY THE <br /> �'�/1�'J OWNER OF THIS PROPENTY TO PERFORM THE WORK FOR WHICH � <br /> / / Z1.1��� ������ APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> . CONTRACTORS LAW 18.27 RCW AND 29G2oJ WAC. <br /> 9GfN1U�iE0fCOHifUC10NON�U1MONiZFOAGINi OALE <br /> - � � � SELECT f10DSES, INC. <br /> �6Y° �J-z�'�� �� b-13'`'1=' � <br /> �.o�eer ec���css <br /> �� S� N'PLIC�NI6QTYtl�5ME5 4CENSlNOANDUUSM[SSNnME <br /> , � �.�G-�- f�}- L)r .� (� <br /> I !~ PLUMBING MECHANICAL <br /> ' N0. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � 3 WATER CLOSET(TOILET) /�� NC-A�HNDLG UNITS-H.P. <br /> � BATHTUl3 'i ; 1 FORCED AIR SYSTEMS-B.T.U. A7 E.A. <br /> '�� 1 , UNIT HEATERS-B.T.U. M <br /> 3 LAVATURYIWASH ppSIN) �� � CLOTNES DRYERS <br /> �'�' � � SHOWER ) 1 <br /> 1 HITCHEN SINK&DISP ,� ; � 1 VENTILATION FAN � <br /> - - RANGE MOOD --r <br /> ], DISHWASHEH �' 1 <br /> LAUNORY TRAV � ' ��1 WATER HEATER <br /> � '+� ] CLOTMES WASH[fl ; � WOODSTOVE _ <br /> UflINAL ' 1 METAL FIREPLACE 8 CHIMNEY %C� ' <br /> DflINKING FOUNTAIN i FIREPLACEINSERT _� <br /> o FLOOR DRAIN HEAT PUMP <br /> �� � DACKFLOW PR[VENTERS -Q GAS PIPING — I <br /> HOOFDRNNS-R�INL@A�ERS E%HAUSTFAN _ <br /> SINK(SERVICE-OAR,ETC.) _ <br /> — y�r�� ' I1 � '�f/1 CiF <br /> _ �� , <br /> r.,,. <br /> SUO TOTAL 3 i��(7;�- SUB TOTAL S �„/i �= <br /> I ���' - _ PERMIT S PERMIT S �_ <br /> �� TOTAL FEE S TOlAL FEE S <br /> .. ����t�i$LItlACN fi[MSElOACN 51D45E7WCN {'W/�'AIECN�WMUEN IEE � �1ECCIPINO <br /> I )� � . � .����.:'7 L7��� / )��i�� <br /> . ! . r_,(.: ::� . <br /> �yl lry�E im u�ce veuwr s�te FEES VALUATION FEE <br /> � )_ , 'L'� ❑ YES ❑ NO �:.'.��,.I C;�-� 5i-)J !:� . <br /> IlU0.DING LL <br /> '�I'IUIIONSt.ulUWNllI IYKqCUNSIILIUN u+.U+-r� bda'M1u1�GUM15 <br /> �ti r� � PIUMUING ��— <br /> i[I tN WUG NOAF StOfl�LS OAS[MEIII MECMANICAL �)D ; — <br /> i i��7 � lJ YES � WO -- ' <br /> ,- �. . _ � .,:g_ Z <br /> .��.GUCnHCYl0A0 FIRESPPNNLEPSNEO� ' AIQU411AilON OTHEH <br /> - N� I.I YES rCNO �'C' SIAIE�WlOWG5UNC1WIGC /� '���:. <br /> �,i�ounra�sai+uaicns -- --_ . �.l.'. i <br /> STQE ENtHGY SWIGWIGE � <br /> ,.��i�i�c.ua�ecenv �w:,u�i.rtonr CITYOFEVE{1E� WIkrCMnYv�a ---�:_(� :''i I <br /> :: . . LOCAI SAIFS I <br /> �#Io�I i' �N� TA7(CODE IS 1105 iou► J(;,l'J l,(' <br />