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APPLICATI^N FOR CONSTRUC'''ON PERMIT ' <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BASIC PLAN: MAPLE (CITY NO. 101 ) <br /> HEATING SYSTEM: O <br /> BUILDING DEPARTMENT �I GAS O ELECTRIC <br /> 259.8810 <br /> h DEMOLITION 00 COMBINATION 0 BUILDING 0 MECHANICAL I I PLUMBING SIGN <br /> OWNER MAIL ADDRESS CITY ZW <br /> SELECT HOMES, INC. 237 ELM ST EVERETT 98203 258-1503 HONE <br /> IENANT IMI ADDRESS CITY ZIP — <br /> NIONE <br /> ARCHITECT OR DESIGNS R MAIL ADDRESS CIT• ZIP - <br /> PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS <br /> BY ZIP <br /> LICENSE� <br /> SELECT HOMES, INC. 237 ELM ST EVERETT 98203 258-1503 PALE SELECHI1110KNTE & <br /> MECHANICAL CONTRACTOR MAI ADDRESS CIT' 21P <br /> PHONE STATE LICLNSF.F <br /> PLUM MCONRMCTOR MAIADM. CRY <br /> ZW PPHONES1AlE LICENSE• _ <br /> CONTRACT PRICE OF WORK- <br /> 40000 <br /> DESCRIBE WORK AND SOLIARE FOOTAGE INVOLVED <br /> CONTACT PERSON AND PHONE NO <br /> SFR Randy Clark 258-1503 <br /> PFIOPOSEDUSEaU BUkom -- I HEREBY CERTIFY 1HAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> n <br /> LEGAL pESOR�JIP�Tq�r pF PROPERTY I&NawN BELOW OR ATTACH ) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �TWO dwa _ _-WORK WILL BE COMPLETED WITH WHETHER SPECII ED HEREIN OR <br /> LOT-�/.l- BLOCK OF -AuaaioArulZOK DIV 7 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCEL TAlI10 NUMBER ApPPLICACT7ION LLIS MADE AND I COMPLY WITH THE STATE <br /> CSELECTO OA .27 BC1k AND 296.200 WAC, <br /> Cp67RUC7gN LOAN LLIILLR,ADDRESS,7ELEPII3NE NUMBER F I[JC <br /> PROJECT ADDRESS ? L1.40,�Y <br /> PLUMBING cRr AIIs.A ss iu Ilst Ro .. <br /> NO. TYPE OF FIXTURE OR ITEM MECHANICAL <br /> 3 WATER CLOSET IFIXTURI FEE ' NO. TYPE OF EQUIPMENT FEE <br /> BATHTUB NC-NHNDLG UNITS-H.P. <br /> 3 LAVATORY(WASH BASIN( <br /> SHOWER UNIT IIEATERS-B.T.U. M , <br /> 1 KITCHEN SINN <br /> 1 CLOTHES DRYERS <br /> 8 DISP ; VENTILATION FAN <br /> 1 DISHWASHER <br /> LAUNDRY TRAY -- 1 RANGE HOGD <br /> 1 CLOTHES WASHER ' WATER HEATER <br /> ' WOOD STOVE , <br /> URINAL ' 1 METAL FIREPLACE(WOOD BURNING( <br /> DRINKING FOUNTAIN I <br /> FLOOR DRAIN FIREPLACE INSERT , <br /> BACKFLOW PREVENTERS HEAT PUMP� I I <br /> G �— <br /> ROOF DRAINS- AS PIPING� ' <br /> ' '—'moi--- <br /> SINK(SERVICE-BAR,ETC.) , ti EXHAUST FAN , <br /> , <br /> , <br /> _ I <br /> 1 I <br /> , I <br /> , <br /> I I <br /> SUB TOTAL f 1 ' <br /> PERMITf , SUB TOTAL f , <br /> TOTAL FEE f , PERMIT f <br /> FOR OFFICE USE ONLY: TOTAL FEE f - <br /> FRONrSE7IMCK WARSETBACI{ <br /> SIDE scrBACK <br /> ZO L PLANGNELKNUMBER FEE <br /> SI <br /> USE ZONE LOT ARE /() N Z2�;-V V�_ tI.IPFNO <br /> VACANT SITE FEES tiALUATION <br /> 12. 2- `� LiTiFS � NO FEE <br /> TrITa Ca15INO OF$TORIEB BUILDING 'y <br /> OCLNAtl' IB aOALGYK mu; <br /> L �_ PLUMBING , <br /> S5W.01 BLDG iKiE SPRYNKLEfl5 <br /> /7S7 RE00 BASEMENT <br /> w� -- i <br /> S! >G t) El YES <Y NO MECHANICAL <br /> OCCUPANCY LOAD FIRE AIAILM REOD NEIGHTUMItA7K* ADDITIONAL PLAN CHECK <br /> REASON V -- 2 c/ OTHER <br /> I ,n' <br /> - <br /> STATE BUILDING SURCHARGE -- <br /> WPo <br /> TAKEBY Arc,uVrle Nvn,Rr _CI-__ OF- I <br /> J %� LOCAL SALES PUBLIC WORKS <br /> 0A11 10 iL 4r3 TAX CODE IS 3105 TOTAL <br />