9229 5TH DR SE 2016-08-31 - Laserfiche WebLink

PROJECT SITE ADDRESS: PERMIT APPLICATION BUILDING �CHANICAL / PLUMBING / SIGN /�INKLER / 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 LEGAL for new construction: Short Plat/subdivision PROJECT SITE INFORMATION S � PROPERTY TAX #: Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: � l �.{�V� }� �jl � TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTaeeT [� /✓�' SE CI71' @X STATE � � ZIP g � � OWNER PHONE: �j '—�P t —C.Q t( 2 OWNER EMAIL: CONTRACTOR NAME: � a, �I e�/�,�i 1'l. �' �� CONTRACTOR ADDRESS: sTaEET � I l �P Z�J/d�^ �I '(�- CI1Y M,V � ( � � ��j �l�l (� STATE W � ZIP D�'4" CONTRACTOR PHONE: �'J � � �� I� CONTRACTOR EMAIL: � G„J� � a/�p �ry�Fb�/t; C b CONTRACTOR LICENSE #(REQUIRED): ,�L�/�,EF �"'� �ps CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):O jZ � PRIMARY CONTACT: ❑ OWNER I�ONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: � J�'S =�',1 � , 7J ��—G�l `�,V�,G� n/�, OIi1, � Z CONTACT EMAIL: S��,Q aS GV(��/Q� BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ —1 �v D 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 G�.�I�o✓1 ASSOCIATED BUILDING PERMIT #(if ap licable): 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 Fi�ctures # 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 Number of Heads ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pu�suant to this permit must comply with current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations theiefrom. Deviations must first be authorized in writing from the Building 0lficial before being authorized under any ci�cumstance. 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. Owner/Auth(Zrized Agent Si�aiure( ) Date City of Everett Official Use Only PERMI # �� (Revised 10/12/2015)