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ATIC-I FOR CONSTRUCT'IN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />4DU-8810 <br />DEMOLITION ❑ COMBINATION I I BUILDING <br />TENANT MAIL ADDRESS' ITV <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY <br />GENERAL CONTRACTOR MAIL ADDRESS CITY <br />I MECHANICAL h PLUMBING <br />ZIP PHONE (/ <br />q&;Io� 2m, 348.34 <br />ZIP PHONE <br />ZIP FHONE <br />G SIGN <br />ZIP <br />PHONE <br />STATE LICENSE# <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMB0 G CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE # <br />I <br />II <br />CONTRACT PRICE OF WORK <br />--CAI E WORK ND 1 REE rOOTAPE INVOLVED ^* <br />'ONTACT PERSON AND PHONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSEDusoF BUILDING <br />S f <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />.1I{—` <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OFWORK. WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />/LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT- BLOCK -�� OF -D- 02 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />tlYT(ot. C) f I �T L5 1p% _ }, <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />�d W (,L't'Qf" <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL I.D. NUMBER <br />14 _ 000 _C%S _ Q2O-1 <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />CONSTRUCTION LOAN LENDER, ADDRE'S, TELEPHONE NUMBER <br />IV41laNAT�O <br />yeaPROJECT <br />•^DRESS7/77/93 <br />•,rlG'11 <br />38'bQvukl l� R'vd <br />GATE <br />Epr 1�' A % <br />v F LIV �'1 O J <br />GITYBUSINESSLICENSENO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSE!' (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A <br />— <br />LAVATORY (WASH BASIN) <br />I <br />. <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />SHOWER <br />CLOTHES DRYERS <br />—r— <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />— <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOODSTOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />I <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />— <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />; <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />f <br />USEZONE <br />LOTAREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES G NO <br />BUILDING <br />TYPE OF COWT <br />NO OF -STORIES <br />QXUPANCY <br />No � MULNG UN115 <br />PLUMBING <br />i <br />GROUP <br />SRE OF BLDG. <br />WRESPRINKLERS RED <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />IIITAKE BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />TOTAL <br />DATE <br />TAX CODE IS 3105 <br />