905 MADISON ST MADISON PUB 2019-11-06

- PERMIT APPLICATI- ill BUILDI• MECHANICAL/ PLUMBING /SI c—• •--PRINKLER/ DEMOLITION E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits blue or;Black In ,Ojnl .Please " ..O ,,.PROJECT SITE,;INFORMATION ,..�... PROJECT SITE ADDRESS: MO (S&A S rierettPROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT`INFORMATION OWNER NAME: hflot l ( S 01) kic lo ,I TENANT BUSINESS NAME(Commercial): `J W OWNER MAILING ADDRESS: STREET 9 0 IC({ r SlM St. ? CITY rt/'C STATE VIA l ZIP 15-203 OWNER PHONE:12..§:"– J OWNER EMAIL: f ( °� ti ci,1 •( ✓i CONTRACTOR NAME: Ps 1 P cay 6,) 11ve , (A j, J� vv-a- r C CONTRACTOR ADDRESS: STREET IL 3 )w 3-rv-v1 SI-_ e�► C(° CITY eo t"1 1 STATE CJ A- ZIP civ 1 O7 CONTRACTOR PHONE: 153 -i13-13- 40-I CONTRACTOR EMAIL: CqCAPel ( gUviAe • Gox,y, CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 253-C('7 3-402.1 ,- 63rtc CONTACT EMAIL: C otY-ct (c Jr it Lc) vi. i .[3UI ..D Io.tstFOiI,ssAT,o).N Existing Use of Building: Contract Price of Work:$ 5-30R. l- Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Ton–A(k Cli 1l V\Still a–lc,Z._ v, (5/f QS tU'l S5 ASSOCIATED BUILDING PERMIT#(if applicable): ',,,.,IVIECHAi511CAL PERMIT,APPLIRATION. y z ,% :.P,1.4M$1$1 PER YLIT IPPLIri A'I'ION , f,... .;.. 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 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 I SUPPRESSION SYSITEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System 72. 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.1 am the owner,or 1 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 �2)( 7 PERM # b CD 17� "' 0OL-jt Owner/Authorized gent Signature Date (Revised 4/15/2019) rT�