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APPLICATI-..N FOR CONSTRUC'. LION PERMIT <br /> ,1� -� * I� evHn•n <br /> BASIC: CEDAR J'1" <br /> Ivof <br /> everett A-4 <br /> IIUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> .,59-6810 <br /> DEMOLITION COMBINATION ❑ BUILDING L I MECHANICAL PLUMBING SIGN <br /> ,.YNLA MAW ADDRE SS cm to PHONE <br /> SELECT HOMES, INC, 237 ELM .STREET, EVERETT 98203 2066 258-1503 _ <br /> .NMI WE ADDRESS CITY TIP <br /> NE <br /> MICWIECT OR DESIGNER MAW ADDRESS CITY ZIP PHONE <br /> .(NERAL CONTRACTOR umAIEDIIf.66 CITY ZIP PHONE LICENSEE <br /> SELECT HOMES, INC. 237 ELM STREET, EVERETT_ 98203 206 258-1503 SELECHI110KN <br /> :F}� MI CHANICAL CONTRACTOR MAW ADDRESS CRY M PN7NE I.X.ENSf1 <br /> D H ,UMBNO CONIRACIOR MAW ADDRESS CRY ZIP PHONE LICENSE <br /> U7 <br /> MS OF WORK <br /> ,a xXNEW I I ADDITION I I ALTERATION I REPAIR El DEMOLITION 1_1 WOODSTUVE/FRPL INSERT I I BUILDING RELOCATION <br /> NANT NPROVEME NT OR KITE AM REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> q NIRACTPRCEOFRAMNZ 4nOOO RANDY CLARK 258-1503 <br /> R"3 t/t Imo) I SCRIBE WORK AND SQUARE FOOTAGE AVOWED <br /> yELryV� GARY KLICK 339-0555 <br /> yQd .ol,"SEDUSEOF BUWDNa 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> O�y M {y �......n oAur r v nccrn>:NCD[ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> Iy M O I wL jF lc lgN PRO•ERTr JSOMI BELOWOEA11ACHFOU wPasl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> Q. C1 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> FH ,.I_A,_ BLOCK OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> 2 3 —1 � }y( .� AUTHORITY TO VIOLATE CANCEL THE PROVISIONS OF ANY <br /> CY" �-�� OTHER STATE OR LOCAL LAW <br /> REGULATING CONSTRUCTION OR THE <br /> 1„I H PERFORMANCE OF CONSTRUCTION THAT 1 AM AUTHORIZED BY THE <br /> 814 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> . 14 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> RJ Com <br /> m I D CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> 94NATURE OF CONIRACTORORAUTNORIZEOAGENT DATE <br /> 1014 <br /> ® •IO ACT ADDRESS 1-� <br /> / _ 5gg97 APKCBCENSE NO AND&1SNE 55 NAME <br /> —) PLUMBING —( MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) I G-AlHNDLG UNITS-H.P _ <br /> 1 BATHTUB 7' 1 FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M <br /> SHOWER / ' 1 CLOTHES DRYERS <br /> KITCHEN SINK B DISP VENTILATION FAN <br /> �8 DISHWASHER 1 RANGE HOOD ' <br /> 7�A>•i' LAUNDflY TRAY ' WATER HEATER <br /> CLOTHESWASHER 7I WOOD STOVE I <br /> URINAL ' METAL FIREPLACE 6 CHIMNEY <br /> DRINKING FOUNTAIN I FIREPLACE INSERT _ <br /> u A OWN FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS I _ EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) too <br /> ' - <br /> I ' <br /> SUBTOTAL f I SUS TOTAL $ ' <br /> C� PERMIT $ I PERMIT $ I <br /> TOTAL FEE S ' TOTALFEE $ ' <br /> .NONT SETBACK AEARSEIBACK SIDE SETBACKPLAN CHECI( FEE R M <br /> ,,E ZONELOT ARE ✓ VACANT SITE FEES VALUATION FEE <br /> A -Z ,j�p��7 ( I YES ❑ NO BUILDING O <br /> RS O CONSI MLoWARI Ern O CWT ACIIIALBEKIA,Er AE o wMM wn - <br /> ABr <br /> PLUMBING <br /> .VE OF BLDG ND OF STORES BASEMENT MECHANICAL b� <br /> 16 7 SF t IJ YES 69 NO , <br /> 6CUPANCY LOAD FIRE SPARKLERS REOT) IIEIDNT LNITATION OTS— _ <br /> VES I+To'NO STATE BUILDING SURCHARGE <br /> ..I ASON FOR SPRINKLERS <br /> STATE ENERGY SURCHARGE <br /> nPKCATIONACC.By PLAISA VEDBY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> s TAX CODE IS 3105 i TOTAL <br />