1812 HOLBROOK AVE 2020-08-27 - Laserfiche WebLink

PERMIT APPLICATION BUILDINC-MECHANICAL / PLUMBING / SIGN 'RINKLER/ DEMOLITION E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I 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: ,9)t, � 7©� PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: TENANT((� TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET \ ? (2e CITY eA 1 ( STATE Ui A ZIP OWNER PHONE: 2.0(47 '1 " J��7�� OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 22\R cry Olckfldsdc STATE �k ZIP 9n_2o CONTRACTOR PHONE: 2-0U _ 7 /i �(0 CONTRACTOR EMAIL: 6^UCieI L-. -\L-(D CSM CONTRACTOR LICENSE#(REQUIRED): c� l��, L ( t� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: KOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Ma_ (.5-3(,„q oLtvw, CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ I OW Proposed Use of Building: Heat Source: ,'Gas 0 Electric ❑Other BUILDING USE: 321sFR ❑Townhouse 0 Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): rJ,aoe3 r. 2.4 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System 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 Stat-Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 1 PERMIT#� � S'[mac / Or/o 9020 tS2OO 3 O Owner Authorized Agent ignature Date (Revised 4/15/2019)