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APPLICATIC-' FOR CONSTRUCTC)N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT L HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />259-P810 <br />❑ DEMOLITION U COMBINATION( BUILDING MECHANICAL OWNER _ ❑ PLUMBING ❑SIGN <br />MAIL ADDRESSu <br />1-71 .21L ,/Z 4w / // c/ D� %j L�'3..i/CITY 21P PHONE — <br />cNANT MAIL ADDRESS �✓C iG �/�� � R� �>4-i z' � "I %.�+ <br />CI'Y ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENEjIf�L CONTRACTOR MgIL ADDRESS <br />/ CIT no <br />CONTRACT PRICE OF WORK -- -- <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED —' <br />CONTACT PERSON AND PHONE NO. <br />-nc <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, <br />TYPE OF FIXT <br />WATER CLOSET (TOIL <br />_BATHTUB <br />LAVATORY (WASH BA; <br />SHOWER <br />KITCHEN SM& DDISP <br />DISHWASHER <br />LAUNDRY TRAY <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK <br />USE ZONE I LOT <br />NUMBER <br />C1 <br />OR ITEM <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />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 AUTHORIZED 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 18.2/7 RCW AND 296.2000 WAC. <br />S GNATUPE OATC — <br />FEE NO. I TYPE OF EQUIPMENT FEE <br />—� A/C—A/HNDLG UNITS—H.P. <br />_ FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />�. CLOTHES DRYERS —� <br />VENTILATION FAN <br />._T <br />' RANGE HOOD T <br />WATER HEATER <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PERMIT $ <br />TOTAL FEE S <br />TYPE OF CONST. NO.OF STORIES <br />SIZE OF SLOG. FIRE SPRINKLERS REO'D <br />REASON <br />INTAKE BY I PLANSAPPROVEDBY <br />DATE <br />SIDE SETBACK FFLAN <br />VACANT SITE <br />FEES <br />❑ YES a NO <br />BUILDING <br />OCWPAWY N00ipHE41NGUNRS <br />GNOUP <br />PLUMBING <br />3ASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />TEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />TAX CODE IS 3105 <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />NO, <br />