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�^` � �",'� <br />APPLICATiORE FAR CUNSTR�b��'IO�N <br />Y�ERMl7' <br />rno Evorgroon <br />CITY GF . ovrrrt 1 <br />�verett � <br />BUILDING DEPARTMENT <br />7.6y.8g10 TO BE COMPLETED IN INK— r LE�wE PRINT <br />OWNEP MM1ILRO�fil55 L'T 'IP �IIONE <br />SELECT HOM�S, INC. PO BOX 709 MUI;iLTEO, WA 90275 827-8196 <br />IEN�Ni MIIILAOOIlE55 CPY ZIP PIIONE <br />n/a <br />AncHrtEcronoesicN[n Mnaaooness cnr zin ruoriE <br />n/a <br />--- _ _ _---_,-.- <br />OENERALLONif1�CI0� MRIlFGO�[55 GILY TII' PIIDNf IICI'll.^l <br />SEL�CT HOM�S, INC. PO IIOX 708 MUKILTEO, WA 9f32i5 827-8196 SELECHI110KC: <br />ML^.HRNICRLCONiRACiOfi MRILADORESS CILV 21P pHOIiE LICENSE• <br />PIVMBINaCONiRAGTOR M�ILA��f1E55 <br />Uf,ENSE � <br />LI-NEK' ❑ ADDITION ❑ ALTERATION ❑ FEPAIR ❑ DEMOIITION ❑ WOODSTOVE/Fi7PL.INSER� ❑ BUILDINGRELOCATION <br />CONTRnCT PRICE OF WOnN� <br />le fami <br />,' <br />.„�.,,��,,,,�� �. e���„�..� <br />sinale fami <br />ior � z e�ocK or _ <br />, _C�I.ENEIAUEN HElU1-}T''a— <br />i <br />+; <br />i — <br />vnaceuooness <br />�. � G�� /��e u, <br />PLUMBING <br />��; NO. TYPE OF FI%TURE OH ITEM <br />Q. WATERCLOSETITOIIEn <br />� �_ BATHTUB _ _ <br />� LAVAT0:7Y(WASHBASIN) <br />�.' _L SHOWER _ <br />LAUNDRVTRAY <br />CLOTHES WASF <br />FLOOR DRAIN <br />BACKFLOW PF <br />�i <br />A <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />ll Y <br />❑ N <br />fl VES ❑ NO <br />� <br />S <br />resid <br />FEE <br />❑ No <br />dy Clark 348-1320/827-8196 <br />g Stirn $u'7-$7.3b <br />I HFREBV CER7IFY TNAT I HAVE READ ANU EXAMINEO THIS APPLICATION AND <br />KNOW ?I1E SAIAE TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS AND <br />OI701NANCES GOVE(7NING THIS 7YPE OF WOf7K WILL BE COMPLET[U W�TH <br />W HETHER SPECI�IED H EREIN OR NOT. THE GRAN7ING Of A PERMIT DOES NOT <br />PRESUME TO GIVE AU7110R11Y TO VIOLATE OR CANCEL THE PROV ISIONS OF <br />AN V O7HER STAT E OR LOCAL LAW REGULATING CONSTFUCTION OR 7HE PER� <br />FORMFNCE OF CONSTRUCTION. THAT I AM AUTHORIZED �Y THE OWNEF7 OF <br />THIS PNG^HRTV i0 PERFORId THE WORK FOR WHICH APPLICAT1�N IS MADE <br />AND I COMPLV WIIH i'![ $TATE CONTRACTORS LAW 1827 FCW AND <br />296.200 WAC. <br />siaruaron oFeoNrnacrononaun�oaizGonc[Nr on�e <br />Se ect Homes, Inc. <br />{X� <br />.1pPUCANiS CI1 V 005 W[SS llf,fNSF. NO ANO OIISW L55 N�MF. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />A/C — A/HNDLG UNITS — H.P. <br />1 FOflCED AIR SYST[MS— B.T.U. M EA <br />UNITHEATERS—B.T.U. M <br />], CLO7HESDRYERS <br />3 VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />G�S PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />TOTAL FEE <br />FEES I VALUATION <br />aw�oiNc <br />]1YEllINp UNItS <br />I PLUMBING <br />nD <br />MECHANICAL <br />UMIIRiIc�N OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCIiARGE <br />PU�LIC WORKS <br />TO7AL <br />FEE <br />$_ _—_ ' <br />S - <br />5 � <br />RECEIPT NO. <br />J �� <br />FEE <br />� 50 <br />� — <br />1 vlJ <br />�i� � <br />m <br />