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APPLI6�11`I0N FOR CONSTRUCTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER <br />MAIL ADDRESS <br />CITY <br />III` <br />PITON' <br />SELECT HOMES, INC. <br />PO BOX 708 <br />MUKILTEO, <br />WIC 98275 <br />827-8196 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />71P <br />PHONE <br />n/a <br />_ <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />Zip <br />PHONE <br />n/a <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />_ <br />CITY <br />ZIP <br />PHONE LICENSE. <br />SELECT HOMES, INC. <br />PO BOX 708 <br />MUKILTEO, <br />WA 98275 <br />827-8196SELECHIll0KN <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />].IP <br />PI,ONE LICENSE . <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />LS NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ e/OODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />WNTRACT PRICE OF WORK'. <br />CONTACT ONAND HONE NO <br />Randy Clark 348-1320/827-8196 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />construction of single family <br />residence <br />Greg Stirn <br />�---- <br />PROPOSED USE OF BUILDING <br />single family residence <br />" <br />I HEREBY CERTIFY THAT HAVE READ AND EXAMINED THIS APPLICATION ANO <br />KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE ALITHCI : , TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LO(C'.tAW REGULATING CONSTRUCTION OR THE PER. <br />FORMANCE OF CONSTRU( :ON. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RGW AND <br />296.200 WAC. <br />SIGNATUREOFCO TRACTOR ON AUTHORIZED AGENT DATE <br />Sele mes, Inc. <br />/ <br />X . / <br />by <br />LEGAL DESCRIPTION C- PROPERTYISIIOWN RELOWOR ATTACH FOUR COPIES, <br />13 <br />LOT BLOCK OF <br />GLEh1HAUEN HEIGHTS <br />PROJECT ADDRESS <br />I - 74 <br />nk SW ,. I <br />L <br />A ICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />15 <br />A/C - A/HNDLG UNITS - H.P. <br />BATHTUB <br />1 <br />FORCED AIR SYSTEMS - B.T.U. M EA <br />_ <br />�2 Mgt <br />LAVATORY (WASH BASIN) <br />21, <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />IF, <br />1 <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINKS DISP. <br />3 <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />l <br />RANGE HOOD <br />LAUNDRYTRAY <br />l <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />l <br />METAL FIREPLACE& CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />l <br />GAS PIPING_ <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE — BAR, ETC.) <br />SUBTOTAL <br />$ <br />/n (1 <br />SUBTOTAL $ <br />PERMIT <br />E <br />PERMIT $ <br />_ <br />_ <br />TOTAL FEE <br />9 <br />TOTAL FEE $ <br />/1 <br />e' <br />FRONT SETBACK <br />REARSETBACKSIDE <br />SETBACKPUN <br />CHEC NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />` <br />TVF :OF CONST. <br />ALLOWABLE/ACTUAL <br />LOT AREA <br />�/�0.�Y8 <br />OGCUPANCYGROUP <br />3 "I LtaA <br />VACANT SITE <br />y vEs ❑ NO <br />NO OF DWELLING UNITS <br />I <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />11YY��. Z� <br />— <br />SU <br />PLUMBING <br />60 <br />SIZE OF BLDO <br />Iql I S"� <br />NO Of STORIES <br />L <br />YSMT. <br />u e <br />MC LOAD <br />!L/A <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED L) YES I NO <br />APPLICATION ACC BY PLANS APPR BY <br />IF C J 01ty"I <br />H EIGHTLINYA11ON <br />1 6 <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />