3205 16TH ST 2020-02-24 - Laserfiche WebLink

PERMIT APPLICATION BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION '1111P*0 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 0 PROJECT SITE ADDRESS: 3Z �/ t 7y 915*g6 ( PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION n/ OWNER NAME: $Tacq E/71D L ,(.s (/N/ TENANT NAME(If Commercial): !V©/V OWNER MAILING ADDRESS: STREET ia3( /* 1-eCKER /J /� .• CITY VSTATE , ZIP fc -Z0/ OWNER PHONE: 1-745.- .2 5 2 OWNER EMAIL: ES7 /1 P/-{/4 er-) V4t'd• CCDM CONTRACTOR NAME: / 'Hg/i3 4r, ES-r6i' CONTRACTOR ADDRESS: STREET /" '37 /QL>%CC 1•Ef !/.0 i ��77 CITY E.v6A,� STATE /4/41, ZIP CONTRACTOR PHONE: 'V2 S2 -4/Az 2 CONTRACTOR EMAIL:E�`�',E"PF/`-(.4/P& �j��t Twp e D CONTRACTOR LICENSE#(REQUIRED): WAr6A7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: '®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: P/4/41/1° ,41, ..s.7". /.c7 CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ One), BB Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler -*Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable)4C.C2 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 • 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 1. —) IDEbT Sk "— ( Owner/Authorized Ag nt Signature I Date (Revised 9/23/2016)