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•APPLICATI -'N FOR CONSTRUC' ;ON PERMIT • <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> 13AS1C PIAN: MAPLE (CITY NO. 107 ) <br /> BUILDING DEPARTMENT HEATING SYSTEM: ®GAS U ELECTRIC U 1 <br /> 159-8810 <br /> I DEMOLITION X COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING 11 SIC <br /> IW.NEIT MAIL-ADDRESS CITY ZIP PIPJN( <br /> SELECT HOMES, INC. 237 ELM ST EVERETT 98203 258-1503 <br /> IF NANI MAIL ADDRESS QTY ZIP PHONE <br /> ARCRITECI OR DESIGNER MAII ADDRESS CITY ZIP MgNE <br /> 1,1 NfFAI CONIfUC10R MAIL ADDRESS CITY ZIP fNM1Nl SUIT IMA NIII.I <br /> SELECT HOMES, INC. 237 ELM ST EVERETT 98203 258-1503 SELECH111OKN <br /> IAFCIIANICAICONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATF IiANSfI <br /> PLUMBING CONTRACTOR MAIL AUDFIES5 CITY ZIP PRONE STATE LICENSE <br /> UxlTRACT PRIGS OF WORK <br /> 40000 <br /> Ix SCRIBE WORK AND STUART FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO <br /> SFR Randy Clark 258-1503 <br /> I <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED T <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> SFR PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> 11 UAL OESCRIPTIUTIpgNN OF PROPEIITY ISHOWN BELOW OR ATTACH TWO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN <br /> Iol —1— mrK:K OF IIANA3PQOK DIV N NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR " <br /> PERFORMA610E OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY " <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH <br /> APPLICATION S LIS MADE AND 1 COMPLY WITH THE ST, <br /> rAncEl TAZID NLIMmR CSGLGCT 1i0A ,1B,7 CW_ANU 29C,200 WAC <br /> I IFONSTRUCYONLOAN TENDER ADOnESs c, 1E"`W S C 11/0 SS IJ( G <br /> j PROJECT ADDRESS SKINAIUN[ I - <br /> [rtr AU:m;t I rt Nv Nn <br /> --- --- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE _ NO. TYPE OF EQUIPMENT FEE <br /> 3 WATER CLOSET(TOILET) I _ A/C—AIHNDLG UNITS—H.P <br /> 2 BATHTUB i 1 FORCED AIR SYSTEMS—B.TU. M EA_ <br /> 3 LAVATORY(WASH BASIN) 7 UNIT HEATERS—B.T.U. M <br /> 1 SHOWER l CLOCHES DRYERS <br /> 1 KITCHEN SINK 6 DISP 3 VENTILATION FAN <br /> 1 DISHWASHER l RANGE HOOD _T <br /> LAUNDRY TRAY ' 1 WATER HEATER <br /> 1 CLOTHES WASHER WOOD STOVE i <br /> URINAL META,_FIREPLACE(WOOD CURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT ' <br /> FLOOR DRAIN <br /> HEAT PUMP --T <br /> BACKFLOW PREVENTERS 1 GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> SUB TOTAL f SUB TOTAL f <br /> PERMIT f PERMIT _ f <br /> 1 TO iAL FEE f ' TOTAL FEE f <br /> FOR OFFICE USE_ONLY: <br /> I)UNIT SETBACK REAR SETBACK SIDE SETBACK PUN CII'CK NUMBCR 141 Ill curl NO <br /> OSA 7 E LOT ALVACANT SITE FEES VALUATION FEE <br /> KALU VACANT <br /> Z F1 YES ❑ NO BUILDING <br /> IN1 Of tuNsl NO OF SIORIAs .. . <br /> —EJ 2 A I PLUMBING <br /> VF Of nI DG FIRE SPnINKLERSn[O'D BASEMEN) � � <br /> Nu I1 YES IcyNO MECHANICAL <br /> OCCUPANC'I l0 D )TIC ALARM REDD RICHT LIMI1AiIi ADDITIONAL PLAN CHECK <br /> ,U -OTHER-_0 �.]//�F /I // <br /> IR.A�J N — k f/V 'DTI/ER— �., /Q_ —__�1) <br /> STATE BUILDING SURCHARGE <br /> MAKE - Vt AN%Arrp0 DY CITY OF EVERETT PUBLIC WORKS <br /> ��JIf LOCAL SALES <br /> DATE / i3 q3 TAX CODE IS 3105 TOTAL <br />