1445 MADRONA AVE 2020-05-08 - Laserfiche WebLink

PERMIT APPLICATIO "111111* BUILDING MECHANICAL/ PLUMBING /SIGN/ RINKLER/ DEMOLITION ii CITY OF EVERETT PERMIT SERVICES 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: 5 MA P P.,ON fl n VS, PROPERTY TAX#:006 OG-10066 2TO/ LEGAL for new construction: Short Plat/subdivision Mew It He A t titi Lot No.A4 (attach copy of long legal description) ^�nn tnr CONTACT INFORMATION OWNER NAME:Mary 11AAG',11.iS ti%so/171 AoR Ill 7 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET i 1 1 5 it cd r"or,,-,` vi-c_ cm( E v es-Et* STATE W i 1 ZIP 9 2 OWNER PHONE: t 2-c '726OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT� fBUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) fV ev'J Own e CONTACT NAME: o .S CONTACT PHONE: 3 6 0 510 9'51'6 3 CONTACT EMAIL: CAR BUILDING PERMIT APPLICATION Existing Use of Building: CAR P0 g-r Contract Price of Work:$ / 7 7 2_, 5 5 Proposed Use of Building: C- P R PORT Heat Source: ❑Gas ❑Electric ❑Other e , A Building Type: . SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addittiion ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: R e cs„cc. S 17._e O e CQ r p 01.'1* by /4C) s +, by re,piacinci moct, re,10C-4:di n(1. 3 pots Tr1 n ever ( o' -Crorel r , Si de, 5 M k,,po sfs 1 n c8ACc ,4e . RQ u e. c s w, _c�1" • NI art - RpnI t $ ` h r ..r+ *-f 1 q 11 i l o ` ASSOCIATED BUILDING PERMIT#(if applicable): lo► 4 Cle- MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°{ 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 ' 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.lam 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 -14 a ) PERMIT �'V �1 - 2� - 17 L-1tf —a31 Owner/Authori gent Signature Date (Revised 9/23/2016)