101 W INTERCITY AVE 2019-11-06 - Laserfiche WebLink

PERMIT APPLICATION BUILDING/MECHANICAL/PLUMBING I 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: /0/ ,h/ /n/?c 2L:rr y A y PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 3 12._A(‘ 44„,; a-,e, ..-- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET /D J /alrelc;-ry Av CITY Xi/40-47-4.- 7 T STATE "```l ZIP 7. %87il�% OWNER PHONE: b Ca-3 v q--- /'fp OW � NER EMAIL: -EA-0.4,k Gi, �C.e,r c 44.5, J , Co,.�. ��J� CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ')arOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION nn ExistingUse of Building: Contract Price of Work:$ \ UV,GrJ---- Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: )"4 SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition L31Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: J r 66,4,57�a P,,:r U r t d✓,07- 7, lip-raze A/�re4- Y��4-cdd d' rG.-,.e., go a6 1 /4 >(i Pe D c e_oSS y �, op c1`e'- f s, i _Io Q c.rk-g e 4-4? �-�`n k i rsS -4�1 4U,, l,,•;;(yt` GN w,44. I .4-( P 4,.> cFcrt,l4-4-- K.-7 q e. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New Addn Alteration _Repair Type of Project: New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal I Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain ( Water Heater Refrigeration 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only � C,�/�j c. ‘/2/ %'i/ PERM 1 t6 6 -- C6 1 Owner/Authorized Agent Signature Date (Revised 9/23/2016)