3921 HIGH ST 2016-08-24 - Laserfiche WebLink

� � � PERMIT APPLICATIO BUILDIN�'IECHANICAL 1 PLUMBING / SIGN : RINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits Blue or Black Ink Only Please 'ROJECT SITE ADDRESS: � � Z � PROJECT SITE INFORMATION tT .GG h S't PROPERTY TAX #: for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: � � �, I � " W-� TENANT NAME (If Commercial): OWNER MAILING ADDRESS: s-rReeT �j 2 � 'c S� CITY �e STATE fitJLl ZIP ��^Q� OWNER PHONE: y Z-rj -� - �[ I OWNER EMAIL: �Q ("'' r'' � �' C CONTRACTOR NAME: i CONTRACTOR ADDRESS: sTrzEer 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: C..� Z� _� 7� -- (p /(� �� VVi,�,.i C CONTACT EMAIL: ��- � C '` � L BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ l� � v� Proposed Use of Building: Heat Source: �Gas ❑Electric ❑Other Building Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�# of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: C��i��QG� �) j�-l' C-� Y�,�.,� O Cv,� /��ti f� ��.'�-� � U ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Fi tures Lisf of Fixtures Fixfures Lisf of Fixtures A/C —Air Handling Units Heat Pump Forced Air Systems Unit Heater Gas Piping Boiler Water Heater Refrigeration Gas Fireplace Wood Stove Gas Range Ducting Clothes Dryer Haokups Other: Range Hood Exhaust Fan SPRINKLER / SUPPRESSION SYSTEM Number of Heads PLUMBING PERMIT APPLICATION Type of Project: _New _Addn _Alteration _Repair �°f List of Fixtures #°f List of Fixfures Fixfures Fixtures Toilet Backflow Preventer (Inside Bldg) Bathtub Urinal Lavatory (Wash Basin) Drinking Fountain Shower Floor Drain Kitchen Sink & Disposal Grease Trap Dishwasher Roof Drains Clothes Washer Medical Gas Water Heater Other: Sink (Service/Bar/Mop/etc.) Other: ACKNOWLEDGEMENT. 1 have reviewed this application and confirm the informafion contained herein is t�ue and correct. Work done pursuant fo this permit must comply with current federal, state, and local law. The granting of a permif only authorizes approved work and no deviations therefrom. Deviations must first be aufhorized in writing from the Building Official before being aufhorized under any circumstance. 1 am the owner, or 1 am authorized by the owne� of this property to perform fhe work for whrch application is made, and ! comply with the State Contractors Law 98.27 RCW and 296.200A WAC. �� .�� G� li' V �c-�.� (.t �- Owner/Authorized Agent Signature City of Everett Official Use Only PERMIT # � ZS l(,, D�� ' �� Date (Revised 5/20/2016)