5102 DELAWARE AVE 2019-11-01 - Laserfiche WebLink

PERMIT APPLICATION 7�� BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 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) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: t) (LJ _ CI_ A - -e- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) T CONTACT INFORMATION OWNER NAME: 3CQ,y _ t Atli TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET tr U Z e ke.1,wOa.c. 2... CITY A STATE 1:1'. 'z_o ZIP OWNER PHONE: {�� /122_' ( / OWNER EMAIL: !�C, nem kAudson Gj5 e Q vna l ( � CONTRACTOR NAME: L' 1 CONTRACTOR ADDRESS: STREET CIN STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: ��8, CONTACT PHONE: —125 —L.2...2`,- L( c In t' �t'l( �vl'1 CONTACT EMAIL: jC V h041301, ), C�� S5 l " liena t 1 r CCS BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ 1.5 *0 E942) Proposed Use of Building: SFR Heat Source: ❑Gas 0 Electric ❑Other BUILDING USE: ®SFR ❑Townhouse ❑Duplex :VDU ❑Multi-Family-#Units: CI Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition Ore model ❑Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use DESCRIPTION OF WORK:°-rW{ BaoccA. w �f`f-r �j�js J-- j/ wfit. g Z,g et-1467 ONO /7oST 12:4177-/. M00C_ KT-TCF/&N 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 A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) / Shower,Tub,or Combo Boiler Gas Range / .iP Clothes Washer Sink-Commercial(3-comp,prep,floor) j Clothes Dryer Heat Pump&Ductless Dishwasher . Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop -2. Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 2. 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, and 1 compl with the State Contractors Law 18.27 RCW and 296.200A WAC. (l �j'� City of Everett Official Use Only •2l✓J 101 PERMIT ®. -® 1 Owner/A hori• d Agent Signature Date (Revised 10/10/2018) P