420 85TH PL SW 2022-03-04 - Laserfiche WebLink

• PERMIT APPLICATIOO #400141,111/%!/—°;-‘ t.UILDING / 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 Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 4 O es i'* (24 SGtJ PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: j/ss/DA//� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 7 /4iv 444 67- SU/72 2/e7 �1 - CITY 90e41/.36 STATE A 2 . ZIP cfS p p‘ OWNER PHONE: (f,ZJ ' 31 S Z f j OWNER EMAIL:,•%44Jt/4*l1 e /tied Oit/j/e ,e12cf• Lp/", CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSEIC #(REQUIRED): PRIMARY CONTACT: El OWNER ❑ CONTRACTOR MOTHER(Please Specify) 4 LV/t�o nJfv v# Cl/oSSZ.Pe.c/6A)o'er CONTACT NAME: CONTACT PHONE: e/y L g3 e:312`G 44V4 o A-AX0A/f CONTACT EMAIL: /14/2.-„loNA fir/ BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of ork:$ #4)� Proposed Use of Building: Heat Source: ❑Gas rIC ❑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 ❑Demolition ❑Change of Use DESCRIPTION OF WORK: sMI Gsr 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 jChemical 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# ,2&t.Sievle oX/A_— �3.-' -2-0kd l)(S03- DSO' Owner/Authorized Agent Signature Date (Revised 9/23/2016)