430 50TH ST SW 2019-09-10 - Laserfiche WebLink

PERMIT APPLICATION BUILDING /MECHANICAL / PLUMBING /SIGN /SPRINKLER/DEMOLITION AIIIII CITY OF EVERETT PERMIT SERVICES ' ' 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION 1 PROJECT SITE ADDRESS: PROPERTY TAX#: 00690t6-40000/7,00 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION ,OWNER NAME: `f-f-0ten6.3, Pri T p pJ TENANT NAME(If Commercial): 01/9 OWNER MAILING ADDRESS: 17/ 0(STREET / 0-0( 93(FA- i::)\/ _..._ CITY 3ort OnroS 4- STATE 15 ZIP 6.d ry OWNER PHONE: , 06.- ?vo- .2))- OWNER EMAIL: TH- ln-$,� -F1)1)S1 !" 'i r1. G ) L p M , CONTRACTOR NAME: it CONTRACTOR ADDRESS: STREET «. CITY "- STATE ZIP CONTRACTOR PHONE: ryft ,CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: M OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ?--O( 'o9 .- - }"o tftC, ' ,1E.f•J CONTACT EMAIL: ,qo D\) BUILDING PERMIT APPLICATION Existing Use of Building: er Contract Price of Work:$ ) A Proposed Use of Building: N1.-- Heat Source: ❑Gas ®Electric ❑Other Building Type: ZtSFR-Detached Cl SFR-Attached ❑Duplex ❑Multi-Family-#of Units;_ ❑Commercial ❑Industrial Type of Project: {&INew glAddition ❑Remodel ❑Repair ❑T.L ❑Sian ❑Sprinkler ❑Demolition OChange of Use DESCRIPTION OF WORK: 6)-OflH 6 6eri _ibtM rN w12-e-V") L-m-vNPP/ p.ivv C.0 rile Lcn NJ c, (Alt-k 0,N , ? p J rvb c q\ , I oic f rJ CJD(,U V) ASSOCIATED BUILDING PERMIT#�if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: ,2j,,,New _Addn _Alteration _Repair Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List or Fixtures Fixtures Fixtures NC—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration j Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I No. of Heads ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply w. the State Contractors Law 18.27 RCW and 296.200A WAC. 1 City of Everett Official Use Only .. PERMIT +I� $ '�(:)C�?')rt) H Ow r/A zerA nt Signature Date (Revised 9/2312016)