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APPLICATIvN FOR CONSTRUC'h iON PERMIT <br /> ,I. „ LPvrm11 <br /> BASIC: CEDAR <br /> rvol. ' vlanl..' h e <br /> everett �- <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br /> DEMOLITION 1 ! COMBINATION ❑ BUILDING I I MECHANICAL PLUMBING SIGN <br /> IANEA MAR ADOIIESS CITY ZIP PHONE <br /> SELECT HONES, INC. 237 ELM STREET, EVERETT 98203 7.06 258-1503 <br /> iI NANT MAIL ADDRESS CT' ZIP PHONE <br /> I.HCHITECTORDESIGNER MAIL ADDRESS CT' ZP PHONE <br /> PENERMCONTRACTOR MAL ADDRESS CT' ZIP PHONE LICENSE <br /> SELECT HOMES, INC. 237 ELM STREET, EVERETT 98203 206 25B-1503 SELECHI110KN <br /> IACCHANICALCOITRADTOR MAI ADDRESS CITY ZIP PHONE LICENSEE <br /> A I'LLAMEMCONTRACTOR MAL ADDRESS CRY ZIP PHONE LICENSE <br /> C H <br /> > y <br /> t" _IAssoFraRA <br /> yLI ALTERATION ❑ REPAIR ❑ DEMOLITION I.1 WOODSTOVbFRPI INSERT l 1 BUILDING RELOCATION <br /> H XXNEW El A.'IDITION <br /> K' y� II NAME IMPROVEMENT OI INTERIOR REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> H IATWTPRCEOFWOIIV: 40000 RANDY CLARK 258-1503 <br /> to H ,A S RETE WORK AND SQUARE FOOTAGE INVOLVED <br /> z Y K ICK 339-0555 <br /> p O "IgPOSED LTA OF WADING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> O H APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> .(GAL DESCRIPTION OF PROPERTY(SHOWN BELAY OR ATTACH FOUR COP" PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> H V 'T co BLOCK OF NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> y �clp� l�rrl�k Did AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> H PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br /> t7 C4OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> H <br /> On 9d H / /� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> Ly'J 6"UTURECOF CONTRACTORS TC <br /> OR OR AUTHORIZED AGENT DATE <br /> Oy X J 1 <br /> y t�l-- <br /> HaEcr AODREBs_ P. <br /> APPLICANTS GTY BUSINIII&SLICENSE NO AND BuswESS NAME <br /> PLUMBING \ MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> 3 <br /> WATER CLOSET(TOILET) I A/C–NHNDLG UNITS–H.P. <br /> 1 BATHTUB ' 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 I <br /> KITCHEN SINK A DISP ) VENTILATION FAN ' <br /> ,_ DISHWASHER I RANGE HOOD -� <br /> ` LAUNDRY TRAY ' I WATER HEATER <br /> CLOTHES WASHER 7 1 WOOD STOVE <br /> URINAL ' 1 METAL FIREPLACE A CHIMNEY I <br /> ' low DRINKING FOUNTAIN I FIREPLACE INSERT ' <br /> FLOOR DRAINHEAT PUMP �— <br /> BACKFLOW PREVENTERS I GAS PIPING I <br /> ROOF DRAINS–RAINLEAOERS I EXHAUST FAN — <br /> SINK(SERVICE–BAR,ETC.) <br /> ATA-aw <br /> , I <br /> `1 1 SUBTOTAL f �/ ; SUBTOTAL $1 EV10 I <br /> 1\ PERMIT f I PERMIT II <br /> TOTAL FEE S ' TOTAL FEE f I <br /> IIDNT SETBACKREM SETBACK , SIMSEMAcK -/ PLAN CHECK NUMBER FEE ,^� RECEIPT NO <br /> Lc/ S V4 <br /> ISEZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> re`2– Cl YES LT NO BUILDING <br /> I FR IX CONST NIOWAMI TYPE O C0141 ACTOR DODIAKY Ao awwurAMln 7(] 5o <br /> �7 L MI <br /> PLUMBIN.7 i <br /> i`aBL00 t NO OF STORES BASEMENT MECHANICILL ' <br /> S E ❑ YES *-f4O T� <br /> +CCIPANCYLOAO FIRESWRMGERS R/Ep_p IIEIOHT IBBTATgN OTHERW i <br /> I I YES 11 NO G-p <br /> .,I AN ORTPRIMILERS STATE BUILDING SURCHARGEEO _ <br /> STATE ENERGY SURCHARGE <br /> AW;ILATIONACC.BY PLANS APPROVED Br CITY OF EVERETT PUBLIC WORKS zc <br /> �] /5�ti? LOCAL SALES CV/ <br /> 'r7 TAX CODE 18 3105 TOTAL 1 7 LTO <br />