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_ � <br /> ,fS t7 scc� '� /D/ (,�.�oCv� �1 Lc c,�' /�La�n <br /> APPLICATION �OR CONS7'RUCTION PERMIT <br /> CITY OF EVERETf• BUILDING DIVISION <br /> 3200 CEDAR STREET• FVERETT, WA 9d201 •259-8810 <br /> ❑ DEMOUTION �I COMB'' ATION f�t BUILDING i-tl MECHANICAL k� PLUMBING fl SIGN <br /> PROJEC r'AUDRESS S� 3/ /O �� I�l1. !�, <br /> OWKEA MAILAODRE55 CITV ZIP PHONE <br /> �elar+ Hrn�a� Tnr 72811 gth pv W #A-201 i� ratt 41A 8204 06/517 9MF <br /> , TENr1NT MAILADOf1E5S CITV ZIP PIIONE <br /> ARCHITECTOROESIG4ER MAILA�DRESS CITY 21P PHONE <br /> GENEI1hLCONTf1qCiOR MAILAO�RESS CIiY T.IP PHONE STATELICENSEM <br /> . �Ct HGnia9.II1C 12$11 Rth AVp W #A— Ol �� r � p]j� 98204 2(1F/Sl't ann� SFTFCTTI7�KN <br /> MECHANICALCONIRACTOR MAILpDUfIE55 CIiV Zlf� PHONE STATELICENSE� <br /> PLUMBW�WH7RpCTOA MAILAODRE55 CIN IIP PHONE STATE�ICENSEN <br /> CONTR�CT PRICE OF WOfIK <br /> � HEATING SYSTEM: [7�1 GAS ❑ ELECTRIC ❑ <br /> D SCR�ND SOUARE FOOT�GE INVOLVED CONT�CT PEqSON AND PIIONE N0. <br /> Construction of one in le amil esidence d Clark 206 513- <br /> _ Beverly King 206/513-9006 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 'fHIS <br /> PROPOSED USE OF BUILOING APPLICATION l�ND KNOW THE SAME TO BE TRUE AND CORRE:T.ALL <br /> Sirqle familv dvrellin PROVISIONS OF LAWS AND ORDINANCES GOVERNI�G THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEOAlDESCRIPTIONOFPROPEHTY�SHOWN9ELOWORAT:ACHTWOCOPIES) NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior �a eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO� OF ANY <br /> OTN�R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> Mesrill Cxeek Gardens D1V. 1 PEHFORMANCE OF CONSTRUCTICN.TtIAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> PAflCEITA%I.D.NUMBF.H CONTRP.CTORS LAW 1027 RCW AND 296200 WAC. <br /> Select Homes, Inc. <br /> LONSTRUCTION LO�N LENDER,ADDRESS.TELEPIIONE NUMBER XBv• �� C Q�,L 3 �/.� �C�S <br /> SIGNATUIIE DATE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM PEE <br /> - 3 WATER CLOSET(l"OILET) � A/C—AMNDLG UNITS—H.P. � <br /> 1 BATHTUB ' 1 FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> � � <br /> 3 LAVATORY(WASH BASIN) i HEAT PUMP � <br /> 1 SHGWER � UNIT HEATERS—B.T.U. M � <br /> 1 KITCHEN SINK 8 L�ISP i 1 CLOTHES DRYERS ; <br /> 1 D�SHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; 1 RANGE HO00 � <br /> 1 CLOTHES WASHER � 1 WATER HEATER � � <br /> URINAL ' WOOD STOVE � <br /> DRIIJKING FOUNTAIN i METAL FIREPLACE(WO00 BURNING) i <br /> FLOOR DRAIN � FIflEPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE i <br /> ' �g' GAS PIPING � <br /> i <br /> i �j EXHAUSTFAN , <br /> i , <br /> i <br /> i ; <br /> � � <br /> SUB TOTAL $ � SUB TOTAL 5 ' <br /> � <br /> _ PERMIT $ i PERMIT $ i <br /> TOTALFEE $ � TOTALFEE S � <br /> FOP OFFICE USE ONLY: <br /> FRON7 SET�ACN REAB SET�ACN SIOE SEiBRCK PLAN CIIEC NOMOEN fEE PEC-IPi NO. <br /> ' �r�,� s ' � % � � �i�is�- <br /> usEzo �� �OiFREA VACANi51TE FEES VALUATION FEE <br /> s,'� nves n No ouaowc G•Z I <br /> HEIGHTLI�AITATION NOOF�WELLING 512EOFBLDGR.1. ' � <br /> � UNITS Z(Y� S F' "r <br /> GZ S �j/3�CACy.._C, P�UM�ING '�7�� <br /> / <br /> OCCUPANCY NO.OFSi0PIE5 OCCUPANTLOAD 9ASEMENT <br /> GROUP �j `� � !dEC11ANICAL I <br /> �'3 L ry,/!.� IlYES IWJO <br /> � <br /> FIREALAPM REO'0 PEFSON ADDITIONAL PLAN CIIECK � <br /> ._�_ <br /> u� OTHER ��vG/LJ i ; <br /> FIRE SPRIN LER REO'0 qE�50N . ' <br /> �� STNE DUILOIIIG SURCH�RGE / j�—/) <br /> TVPE CONSf P�qNSA�P 0 EDBV i. C <br /> \�� CITY OF EVEREI'T PUI3LIC WORKS �/�� <br /> LOCAL SALES <br /> �'� onre ,j lZa� S TAX CODE IS 3105 TOTAL —,� � � � , <br />