4717 S 4TH AVE 2019-11-15 - Laserfiche WebLink

IIII III PERMIT APPLICATION IOW-- BUILDINMECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 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: '-17 C 7 S 4 V. E v*e tr PROPERTY TAX#:06 j C 4GO2 -0(,r- 06 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) /�tt CONTACT INFORMATION OWNER NAME: Bali 0/ S 4, We, Pf'el' TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET Li 7/ 7 S 4L tµA v q'_ CITY v C V a7 STATE Wet. . - ZIP ?f?Z 03 OWNER PHONE: V 2.,‘- jam/ ^0 9 4 OWNER EMAIL:46 j,!•ly�j I/e5 q5 16/0 at Ala 4.14,/ .to-..• CONTRACTOR NAME: 0IA/ y4'rV / CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: WNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACTi'Z NAME: d CONTACT PHONE: a - �Ql --0 ?6 0cy►y i S Ai., '� -3 i CONTACT EMAIL:y►O ki it, V4,151_2610 1,410Fi kCio A BUILDING PERMIT APPLICATION Existing Use of Building: I Contract Price of Work. Proposed Use of Building: Heat Source: ❑Gas h: - ' ❑O - Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: DCommercial ❑Industrial Type of Project: ❑New ❑Additi n ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK:4i I , � ,,7-- Gt 'Q i J,c 0 74-i /�'j ECGC e iN c 4< ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New_ Addn _Alteration Repair Type of Project: _New 1rAddn _Alteration _Repair #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f 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 Gas Piping Boiler ,/ Lavatory(Wash Basin)' / Drinking Fountain Water Heater Refrigeration / Shower tk Floor Drain S hr.,w c F 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 properly to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW d 296.200A WAC. COity of Everett Official Use Only �i `ci"3l PE . C- ` 0`J 3 Owner/Authorized gent S' ture Date (Revised 9/23/2016)