9105 10TH PL W 2020-08-28 - Laserfiche WebLink

44-77 PERMIT APPLICATIOIG BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION 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 ar Buck Ink*#y Please);• PROJECT`SITE IlNFO MATIOI`I . PROJECT SITE ADDRESS: f4 ' PROPERTY TAX#: �G d -s"0©DdZZUD LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) ©IATA TIN II<MA7 IQN - , "E-= l Co7 OWNER NAME: % ��G TENANT NAME(If Commercial): '2//9 OWNER MAILING ADDRESS: STREET 57/d3 lit -7 .17L G- CITYp STATE ZIP `.049 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ' CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ETHER(Please Specify) � �� CONTACT NAME: CONTACT PHONE: 2 c'' Z. Y. CONTACT EMAIL: Y-s'4 orcky.E'. y� a C V.q•• 04v . BUIL tNG ERMI 'API U ATION l:: Existing Use of Building: - " ' Contract Price of Work:$�, t, 0.a) 1p C> Proposed Use of Building: -5- Heat Source: ❑Gas igElectric L IOtner Building Type: ❑SFR-Detached RSFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: CI New ®Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: „,eU ,��'T�,,, _ ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION Pl UMBING PERMIT.APPLICATION ': Type of Project: _New Addn Alteration _Repair Type of Project: _New XAddn _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 Z Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Z Bathtub Urinal Gas Piping Boiler 3 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: 2. Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: $PRINKLER/SrUPI�2,IwSS[QN $1itSTBM ” , 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 1:.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMI jz — 04 9 Owner/Authorized Agent Signa re Date (Revised 9/23/2016)