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APPLICATIOrd FOR CONSTRUCTION PERMIT <br /> Bir CYnrgrmn I'PI'fl'11 <br /> CI I Y CF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I i DEMOLITION i i COMBINATION BUILDING MECHANICAL X, PLUMBING SIGN <br /> OWNEa <br /> MAIL ADDRESS CRY ZP PHOU <br /> SP1ert- Homes, Tn 977 r1m_s},_Fvj raJ�_WA, 9H2O1-1971 206-25 -150 <br /> TENANT MAR ADDRESS 'RY a -1 <br /> ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAL ADDRESS CRY ZIP PHONE LICENSE/ <br /> Select Homes Inc. 237 Elm Street Everett WA 48203 206 258-1503 SELECHI10KN <br /> MECHANICAL CONTRACTOR MAL ADDRESS CITY ZIP PHONE LICENSE/- <br /> PLUMBING CONTRACTOR MAL ADDRESS CRY ZIP PHONE LICENSE/ <br /> CLASS OF WOIK <br /> k�NEW I I ADDITION I I ALTERATION I I REPAIR 11 DEMOLITION r I WOODSTOVEYFRPL INSERT I I 3UILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> CONTRACT PRICE OF WORK: Randy Clark 348-1320 <br /> DESCRIBE WORK AND SOUAnE FOOTAGE INVOLVED <br /> _.ran atruAc inn CR'iL_ <br /> PROPOSED USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> -3 rNaai Ac,nco APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> LCV 1 RIPTION O PaOPERTY ISHOM BELO.NOR AITACH FOUR:OPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOT� RLUCK O �1dII8broo WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> 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 AU FHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RICAN AI:0 298.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AL ENT DATE <br /> Select Homes, Inc. <br /> wiAPI,E ASIC X� <br /> PnGxcT nnnness 1 '{/�� u � -yLZ <br /> 7-7- /�l/ 1 I 56 A i5 C11/BUSINESSL CENSE.NG ANn BUSINESS NAMI <br /> PLUMBIN MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET( _ A/C-NHNDLG UNITS-H.P. <br /> I <br /> BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. I <br /> LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M ' <br /> SHOWER <br /> • ' CLOTHES DRYERS �— <br /> KITCHEN SINK 8 DISP i VENTILATION FAN I <br /> -� DISHWASHER , RANGE HOOD ' <br /> LAUNDRYTRAY ; WATER HEATER I ' <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL _ ' I METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN _ , FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP , <br /> _ BACKFLOW PREVENTERS i GAS PIPING <br /> ROOF DRAINS-RAINLEADERS I EXHAUST FAN <br /> SINK(SERVICE-BAR.ETC.) <br /> i 5r (' 01 - <br /> I <br /> I 1 <br /> 1 i <br /> _ SUB TOTAL $ A0i - SUB TOTAL - <br /> PERMIT S I PERMIT f I <br /> TOTAL FEE f ) TOTAL FEE E <br /> FRONTSETRACK LftlIAR,SETBACK SIDE SETBACK PLANCHECKNUM R FEE RECEIPTNO <br /> 20 20 5' �' 77 9P 30 A7S� <br /> USE ZONE REA VACANT SITE FEES VALUATION FEE <br /> –Z 3(3t VES ❑ NO BUILDING ' <br /> TYPE OF CONST MIDWABIE TYPL IT COM:ACTUAL <br /> t J <br /> k3 ApA / <br /> PLUMBING <br /> SITE Of BLpp NO OF STORIES BASEMENT I <br /> 1757 3f f ❑ YES ONO MECHANICAL OI <br /> OCCUPANCY LOAD FIRE SPRNKLERS REOD HENTIn I IMITATION OTHER I <br /> _ IJ L; YES f NO `-"' I g <br /> STATE BUILDING SURCHARGE I <br /> REASON F RSPRMKLEnS 6O <br /> STATE ENERGY SURCHARGE ' <br /> I <br /> APPLICATKMNACC BY PI ANS ArrrinvrnnCITY OF EVERETT PUBLIC WORKS V I 61v`OCALSALES <br /> /} TAX CODE IS 3105 TOTAL U <br />