215 DORN AVE CD 2022-01-24 - Laserfiche WebLink

U N ITS C; •(4 -77 • PERMIT APPLICA I IO• 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits ((Blue or Black Inca Only Please) PROJECT ECT SIITIE INFORMATION PROJECT SITE ADDRESS: '2 15 U 0 Y tr.- A \ ,3,,,i�-t-i-- L&- -S2c.PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT lalF' MATIOM OWNER NAME: LJi c rolo AVe.t\G1 4nc E Fl (RI`e i T 1 AN+kA(IVIE(If Commercial): OWNER MAILING ADDRESS: STREET t O (, be,v coy' \y L_.�h l CITY E.v -Y e,-'�^-{-- ` STATE W 'k ZIP 98 2,03 OWNER PHONE: (y,25 / 3 4 6 —0 OWNER EMAIL: eCAUG,Ydb0AIer�Clnc'B33i1n� `• CQ11. 1 CONTRACTOR NAME: C�W Neg "?7V 1 L U CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: "OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION aD Existing Use of Building: >F Contract Price of Work:$ ' ) '2i I Proposed Use of Building: 17 U?L-e is(96QT4'L Heat Source: I�Gas giffiectric ❑Other Building Type: DSFR-Detached ❑SFR-Attached ZDuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial Type of Project: ew DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 'wfl C'b 7 (-2.) p.J ri- � 4( P-I.J1--1 A C s7U R i'' ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION 1 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) 1. Forced Air Systems Unit Heater ,�; 'Bathtub Urinal 2 Gas Piping Boiler . Lavatory(Wash Basin) Drinking Fountain a Water Heater Refrigeration _ Shower Floor Drain Gas Fireplace I Wood Stove Z Kitchen Sink&Disposal Grease Trap -i Gas Range I Ducting Dishwasher Roof Drains 2 Clothes Dryer Hookups Other: - Clothes Washer Medical Gas /7, Range Hood - Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: —vSPRINKLER/SUPPRESSION SYSTEM Chemical or Water yJ 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT 4 . /6 (2_6 I 8 C. /SOS -at 0 r/Authoriz gent Signature Date (Revised 9/23/2016)