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DWIT G-1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> 28osigoo/03Zv0 <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> 19'o I it5`r - p I St Lg'oe79no!t93Y-ao C1 9- 04S <br /> Pt -it"l4 of "Gr• I- <br /> LEGAL for new construction:qShort Plat/ssubddivision - , Lot No. (attach copy of long legal description) <br /> OWNER f 41.0AM C * I-LC Phone/E-mail LL z h.e1 w.ct4A a paei f'►t,rl d,@ kr'MMes,Gom <br /> Address 17IZi ISD 1,E%/ &t'r Wet StaTF h27 City/State/Zip gp llru_ t w,4• RBt2I?- <br /> APPLICANT: <br /> APPLICANT:_Owner ✓Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR SSG State Lic.# City Bus. Lic.# <br /> Address SIS as a.bpt . Phone/Email Sizmkt tar abDue <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail $ . ar XtoOW_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1 ZZ6� v .4- <br /> Existing Use of Rut"'..- H/A HEAT SOURCE: <br /> , <br /> Proposed Use or building_ A,TTAC-4S.0., -rt,IAAM Gas ✓ Electric Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Mufti-Family _Commercial <br /> ---Type of project: ✓New Addition Remodel Repair T.I. Sign Sprinkler_Demolition_Change of Use <br /> IESC RIPTION OF WORK(additional space provided on the back): <br /> NSIO SIJ i(OM VkA 1T G-1 1zS 1 r 7& 00 t <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New_Addn _Alteration_Repair Type of Project: ✓New_Addn Alteration Repair <br /> Show Number(#)of fixtures A Show Number(#)of fixtures <br /> A/C-air handling units T Toilet <br /> / Forced air systems Z Bathtub <br /> Z Gas piping 5' Lavatory(wash basin) • <br /> / Water heater / Shower <br /> Gas fireplace / Kitchen sink&disposal <br /> Gas range / Dishwasher <br /> J Clothes dryer i Clothes washer <br /> / Range hood <br /> j"' Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heatum ( Backflow preventer <br /> p p <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration I Floor drain • <br /> Woodstove Grease trap <br /> Ducting ( Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> „ereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 6.2 OA WAC. <br /> 17- <br /> 2 <br /> -2) , <br /> Owner/• nzed Agent Signature Date (Revised 3/2[713) <br />