3511 UPLAND AVE 2020-09-04 - Laserfiche WebLink

PERMIT APPLICATION 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 I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 3511 1.1, hol f l/-iC✓I1� PROPERTY TAX#: 90 133 �j o() 550 2__ LEGAL for new construction: Short Plat/subdivision Lot No. / ®Q(attach copy of long legal description) CONTACT INFORMATION OWNER NAME: f o,ofo n Wo,M Z S z j C TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 91 zo - /s STTAATE wi ZIP rzog OWNER PHONE: iZ S X76 // O OWNER EMAIL: Go'p/j, Co=n's CA172, *71— CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): Gp rci0/lL 8S/Q/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: A.OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: s- 6ociti CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: j7,e Heat Source: Gas ❑Electric ❑Other Building Type: , SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project:jNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING/ PERMIT APPLICATION Type of Project: VNew_ 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 NC—Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) / Forced Air Systems Unit Heater / Bathtub Urinal 4 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: Exhaust Fan t Sink(Service/Bar/Mop/etc.) Other: SPRINKLER I 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 hein%authorized und-r 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 L-( 8.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# IP Owner/Auth.rized Agent Signa ure Date (Revised 9/23/2016)