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� <br />fheEocrgreen �� ������������ <br />CITY OF <br />���Y�e�� PERII�IT PERMITNO. _ � � � ��' <br />25�-8810 <br />❑ DEI.IOLITION f� COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PL:.IMBING ❑ SIGN <br />OWNEP MAILApD9E55 CITY ZIP ,.,� PHONE <br />Select How�s, Inc. P.O. Box 708 Mukiltc _ 98275 � �-" ij ��� — <br />TENFNT MAILA��RE55 QTV ZIP f'HOt�E <br />,�NCMRECTORDESIGNER MAILAD�PE55 C�iY ZIP PHDNE <br />GENERALCONTRACTOR MAILAD�fiESS CITY ZIP PMONE LICENSE+ <br />Owner DEL�CHIl10KN <br />MECHANIC/LCONTRNCTOR MAILAD�RESS CITY 21P PMONE UCLNSEa <br />P1.Uld�INGCONTRACTOR MAILAD�RE55 CITY ZIP PMONE UCENSEu <br />C1.A55 OF WORK <br />p NEW <br />❑ AD:ITION <br />❑ ALTERATION <br />❑ HEPAIR <br />❑ DEMOLITION ❑ BUILDING RELOCpTION <br />CONTACT P[FSON AND PHONE NO. �F U �ME�� i nnrv nuvvc <br />CONTRACT PRICE OF WORK' $ I — <br />�ESCRIpE YlORK ANO SOl1ARE FOOTAGE INVOLVED <br />New Construction <br />FROPOSED USE OF �UILOING <br />Sinqle familv residence <br />LECAl0E5GlUPTION OF PPOPEPTY �SHOW BELOW OA /TTFCH FOUR COVIES� <br />�oi 9 BLOCH—OF Glenhaven Heights <br />J0� AppRESi <br />PLUMBING <br />NO. TYPE OF FI%TURE OR <br />� WATER CLOSET (701LET1 <br />LAVATORY (WASH 8��: <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNORVTRAV <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />ROOF DRAINS — RAINI <br />SINK (SERVICE—BAR. <br />FRONTSET�ACK <br />20 <br />USE ZONE <br />R-3 <br />tta� aF cousrnucnoN auo�sae� <br />V-N <br />SIZE GF �L�G <br />1728+452 gar <br />OCCUPld�CY LOAD <br />r+Enso�+For+saaiHK�ens <br />41. td. <br />SUBTOTAL <br />PENMIT <br />TOTAL FEE <br />iVEAR SETBACN <br />20 <br />LOT AREn <br />V-N <br />NO.OFSTOhiCS <br />2 <br />FIRE SPHINRLERS REO'D <br />❑ YES O>NO <br />dV I P��NS f�PPROVED BY <br />J.H. <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />ZS O NC—A.'HNDLGUNITS—H.P. <br />5 FORCEDAIRSYSTEMS— <br />�5 UNITHEATLRS—B.T.U. M <br />r� CLOTHES DRVERS � <br />� OO VENTILATION FAN '' <br />q � RANGEHOOD <br />WATER HEATER <br />5 WOODSTOVE —�y��� '' <br />METAL FIREPLACE 8 CHIMNEi"-" <br />FIREPLACEINSERT � <br />HEATPUMP � <br />GAS PIPING �— <br />E%HAUSTFAN � <br />5 5 SUBTOTAL <br />5 PEFMIT <br />S TOTAL FEE <br />SioESETBnCK PLAN CHECK NUMBER FEE <br />6 90/23798 Basic <br />vn�avr siTe FEES <br />YES ❑ NO <br />�?�a„c� NooFflt7ELiiHcuWiS �UILDING S <br />, o�•� — <br />R-3 1 pLUMBING <br />�AS[IdENT <br />❑ vF.S KJ NO MECHANICAL <br />HEIGMTIIMITAT10N OTHER <br />28 - <br />— STATE BUILDING SURCHARGE <br />STATEENEFGVSURCHARGE <br />CITY CF EVERETT pUBLIC WORKS <br />LQCAL SALES <br />TAX CODE IS rorn� <br />3105 WHEfJ PROPERLY VALI <br />PERMITS EXPiRE IF WORK IS NOT COMMENCED WITHIN <br />180 DAYS OR CEASES FOR MORE THAN 180 DAYS. <br />ADUR[SSIIL[ <br />FEE <br />� <br />5 <br />S <br />RECEIPT NO. <br />THIS IS YOUR <br />�i ;r� I1 �1 <br />. � :', �- <br />� �� <br />5� <br />� <br />