2930 MAPLE ST KAISER PERMANENTE 2019-11-06

PERMIT APPLICATION BUILDING�ECHANICAL/ PLUMBING /SIGN / .INKLER/ DEMOLITION _ __J CITY OF EVERETT PERMIT SERVICES N� � f 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: :2_9,3 t v p (5 'P f PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: e-\, TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 9q.3C Map Sr c '1�1M cITY .j�iW 1..�"� STATE 'l.li A4 ZIP ct 5 a`j/� I OWNER PHONE: L tJt��v .n i^y�lQ9 OWNER EMAIL: U CONTRACTOR NAME: C t\ '$"(\A CONTRACTOR ADDRESS: STREET ---/)Qc-- _ S . CITY S_Q k STATE L.Yrfr ZIP qe 13 CONTRACTOR PHONE: abs'7 tia Li- Gj T CONTRACTOR EMAIL:--ki- \ -j i\,/t.C, l �) .00 CONTRACTOR LICENSE#(REQUIRED): Afi C K iA/GL 9q OW CITY OF EVERETT BUSINESS LICENSE#(REQUIR=,'): Li 9 2 PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: lb.- B 39,-160%3 J Sgi \1.Q- CONTACT EMAIL: .CV---k1 r C9 vv.._ BUILDING PERMIT APPLICATION Existing Use of Building: oAstciscrak Contract Price of Work:$ \SZ O Proposed Use of Building: VHeat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial Type of Project: ❑New ❑Addition El Remodel ❑Repair )73 .1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ©1.Q._ (A /�SvY\'c)�'L-'-Qr FAQ \ x.) c Q Ao, o L�CLQQ. . �.Rbv 1 115'PY1v\,k-V \&Q. QQ4_U aktovl P05 .\\o‘.2. °)'-(3"6" 1 �, ASSOCIATED BUILDING PERMIT#(if applicable): 407-0,-- 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 NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal 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/SUPP SIOI'1. YSTEM Chemical or Water I 'S I o.of Heads ACKNOWLEDGEMENT:I have revie d this applicati 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 tin 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 Cont ctors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# K.V \2 - co5 � l2 2� Owner/Author' ed Agent Signature Date (Revised 9/23/2016)