1611 24TH ST 2020-06-18 - Laserfiche WebLink

4rETT PERMIT APPLICATIOJ BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1 61 1 24th Street PROPERTY TAX#: 00439149001701 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Forma Construction Co. CONTRACTOR ADDRESS: STREET PO Box 11489 CITY Olympia STATE WA ZIP 98508 CONTRACTOR PHONE: (206) 626-0256 CONTRACTOR EMAIL: robw@formacc.com CONTRACTOR LICENSE#(REQUIRED): FORMACC878OR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054396 PRIMARY CONTACT: ❑ OWNER gi CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (206)475-0792 Lori Nicholson CONTACT EMAIL: LoriN@formacc.com BUILDING PERMIT APPLICATION Existing Use of Building: Residential Contract Price of Work: $44478.10 Proposed Use of Building: Demolition Heat Source: EGas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 4nDemolition ❑Change of Use DESCRIPTION OF WORK: Demo Residence down to foundation and clear site down to rough graded soils .ice "est 11 L�-I.J j U 'jb e r (-0 �rS u wv,�ifc� LJ v l Ste_ '�t 1�1 S It� ' ASSOCIATED BUILDING PERMIT#(if applicable): 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 Number 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 PERMIT# r r 1 .0 sulk; p l c' —00/ / Owner/Aut o ize. Agent Signature Date (Revised 9/23/2016) 7-