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Q,PPLICATI N FOR CONSTRUC". :ON PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �"�T <br /> BASIC: HOLLY (City No. ) <br /> HEATING SYSTEM: 4lU�AS O ELECTRIC ❑ I <br /> �UILDING DEPARTMENT <br /> 259-8810 <br /> DEMOUTION !�!XCOMBINATION ❑ BUILDING I 1 MECHANICAL i ;PLUMBING i ! SIGN <br /> ..:.nO� AUiI nD�fil55 LITY 2�P PIqNE <br /> _�iF['T HOhLF,$_, INC 2�� FrM ST FVERETT WA 98203 258-1503 <br /> n Nqryi MML AOORE55 ��TY Z�P Pf10f�E <br /> �.'+CnrtECTOROESM.NEP AU��ADORE55 Gtt 21P P110NE <br /> ,�ntqqL CONTp�CTOR 1A�i�ADONE55 Citt ZiP P�qNE Si�tE LiGENSC� <br /> S � T HOMES INC. 237 �ELP1 ST EVERETT WA 98203 258-1503 SELECH1110KN <br /> r� �H srtCnANICnLCO111PAGtOR MALLADDRE55 CIIY 2�P PnOnE SGiELit[NSE� <br /> � � � <br /> ���UMBiNGGONiPeCIOH MA0.ADDRE55 LITV .iP PHONE St�1FiICENSE� <br /> A � x <br /> Ca h� <br /> C yrr��.. � �40000�EOFwonK � <br /> H �'�' <br /> �] H i��.:CPiBEWONKAH�50UAREFOOi�GEINVOLYED CONT�CTPEHSONN�OVNONENO <br /> FC C] — <br /> H �1 <br /> � H � 258-1503 <br /> V1 H <br /> yz . <br /> i HEREBY CERTIFY THAT I HAVE READ AND ERAMINED THIS <br /> � y ty rnoroseo use oF nmio�nc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> O� �� PROVISIONS OF IAWS AND ORDINANCES GOVERNIfJG THIS TVPE OF <br /> ��c.�oe�cR�iPtIONOFOR01'ENTY�SnOWNBEIOWOR�TTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> p., �q7 .0 7. Hanabrook I1].V 3 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> z N 3 iO1� 01°°" ��7 a AUTHORITV TO VIOLATE OR CANCEL ?HE PROVISIONS O° ANY <br /> .�.� y z RA S�(� G��2 OTHER STATE OR IOCAL lAW REGUL�TING CONSTRUCTION OR THE <br /> - PERFORMANCE GF CONSiRUCTION.7HAT I AM AUTHORIZED BV THE <br /> � ~y OWNER OF THIS PfIOPERTV TO PERFORM THE WORK FOR WHICH <br /> N N APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> p t7 y ��nr�c6�r�a i o r+uueen CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ��r, Sele Homes, INc. <br /> L� �UNSiRUC710NLWMl[NDEN.�ODPESS.iEIEPHONENUMBER � /�J� �} p <br /> HOtNi� �A/ �y 3 <br /> l[hv• WLt�Vl �Ci � -�'1 ` 1 <br /> PROJECTADDHESS / � / ��� - o�u <br /> ` Gr M15Mf 591Clx5k Np <br /> PLUMBING MECHANICAL <br /> . NO. TYPE OF FIXTUHE OR ITEM 'FEE NO. TYPE OF E�UIPMENT FEE <br /> j WATER CLOSET(TOILET) NCrNMNDLG UNITS-H.P. <br /> � BATHTUB ' PORCE�AIRSYSTEMS-B.T.I;. M EA. <br /> �=1 LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRVERS <br /> 1 KITCHEN SINK 8 DISP ; \'ENTILATION FAN ' <br /> �T <br /> 1 DISHWASHEH RANGE HOOD � <br /> I��' LAUNDRY TRAY WATER HEATER ' <br /> i S_' - —___-.�_. _. <br /> CLOTNES WASHEH WOOD STOVE <br /> URINAL ' METALFIREPLACE(WO00 BURNING) <br /> DRINNING FOUNTAIN FIqEPLACEINSERT <br /> ' � FLOOR DRAIN HEAT PUMP _ <br /> �' 1 DACKFCOW PREVENTERS �_ GAS PIPING <br /> FOOFORAINS-RAINLEADERS � EXHAUSTFAN <br /> SINK(SERVICE-UAR,ETC.) ; <br /> �'= � <br /> I <br /> SUB TOTAL 5 i� SU�TOTAL E <br /> ���. PERl11T S PERMIT S <br /> TOT.LLFEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> iI�ONI�5E7i0.�KN R[AliSETBACN � Si�ESE1BI/�G1(�/ PlANG1ECItNUYOER FEE � N[CEiPiNO <br /> !�/ � Gl� �7 ��� i' ��7 � � )'-- � :� � �J �i <br /> �n�2a+[ ' �m encn � VAC�VIi SITE FEES VALUATION FEE <br /> � �—� �f��J ❑ ves ❑ r:o suaoir,c 58 53F.'� _�'�5� — <br /> ��y(q(qu�. NO OG 5ipilES ocU�wCr n n MuuCwn <br /> � PLUA/BING <br /> -IJ I <br /> �,iZCOFOLDG. F111ESFPJLCLEPSPEOD B�SEYENT � <br /> �133 SF t ❑ YES (g Np MECNANICAL ��� `__ <br /> °I � F G 2 0 <br /> uCCUPANCYLWO RH[NAiWPEO'D NCIGNTlW1UT10N �OITIONALPUNCNECN � <br /> v1 nwr� n O 2`i' OTMER — <br /> �_—_ <br /> STATE BUILDING SUHCHARGE <br /> ��(J <br /> ,�+�nK�ur eursnrrnovcoer CITYOFENEREff rutu�cwowcs � <br /> LOCAL S11LES <br /> o.�e y Z 3�y3 TAI(CODE!S 3105 TOT11L %� /Z �0 <br />