1914 ADAMS AVE 2019-10-30 - Laserfiche WebLink

"IPPze4V—_,—.4PERMIT APPLICATION BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES � �M��9� 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) ,, SITE INFORMATION +PROJECT SITE ADDRESS: jcp y iA tel.t S J L' t i. r c f PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION - --- A__, -- -_ 'OWNER NAME: ntht-v` E ihr3 _/4"t TENANT BUSINESS NAME(Commercial): w OWNER MAILING ADDRESS: STREET l�1/ '' 4 P4 yn S k✓-c. t11/ , CITY /274-0/-C11— 1.- /STATE / ZIP '�2i`/3 OWNER PHONE: /'2 — j -9223 OWNER EMAIL: CONTRACTOR NAME: QW Kt( CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: OL -C-Nr— CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ 2 Rc. Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: CI Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.'. Cl Sign ❑Sprinkler ❑Demolition CI Change of Use DESCRIPTION OF WORK: / , Wil a-c- r�,.p,/c i ®F. ad SA-� 4- (°"51?-15.C__ ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures NC-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System 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, comply with th tate Cond tors Law 18.27 W and 296.200A WAC. City of Everett Official Use Only PERMIT# - .e civl20Iq ir,dtgof- oat Owner/Authorized Agent Sig . u� Date (Revised 10/10/2018) 0.----