1740 MADISON ST 2019-11-06 - Laserfiche WebLink

= PERMIT APPLICATIO1{ BUILDING I MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION EVERETTCITY 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 I www.everettwa.gov/permits (Blue nraBlack Ink„a my•Pleased. ,.PRCJECTSSITE,INFORMATIO ;, ..., ._.. _ x , ,, „ PROJECT SITE ADDRESS: 174 O /OA 01 50_0 ST PROPERTY TAX#: 0 0 S 1-g-4.00000 SO2 LEGAL for new construction: Short Plat/subdivision 'PiNgwaST "Div. G. Lot No. €.As7 H-ALf or_L 07,5- 7 f S . ,:,CONTACT INFORM iIlTIO7i11. OWNER NAME: I4I-I Lm A kt S)f 1c TENANT BUSINESS NAME(Commercial): ) OWNER MAILING ADDRESS: STREET 'Pc9, E©x 12.35 ' cm, 1 V -Z.��r _ _ STATE RIA ZIP 9$2-O OWNER PHONE 2'5 - 5 1 'i ei OWNER EMAIL: CONTRACTOR NAME: 0 W AlE-I L CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: j OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 415-355 - 149.9 tJ - LM A At CONTACT EMAIL: BUILDING I[RFCI+CKATIi>iN ... ,. ' Existing Use of Building: Sf IZ Contract Price of Work:$ ( 1/1t. °11-. Proposed Use of Building: 51=2 Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse El Duplex ❑ADU OMulti-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Re PLA C6. I4 A7'r.#2 I-k A?- ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL:PERMIT APPLICAT)O1+1 PLU ., . MBING PERMIT/I►PPLICtiATyON''r ,.. U.: 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 Ventilatior 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 I Water Heater '; SPRINKLER i SUPPRESSIONI 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.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 , PER I U 01 __ 00� x/1/2`,9 0 ed horized Agen Signature D td a (Revised 4/15/2019)