4721 BELVEDERE AVE 2016-10-20 - Laserfiche WebLink

PERMIT APPLICATION BUILDING ,&CHANICAL/ PLUMBING / SIGN /SINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES OL 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1t 7,f e/VeJeeLAve— ,-v 4'11 t ;,1ROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 6l/e 1-4 J24,156'.7 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET / Z/ 6 1-lUtj tZ CITY tve'L STATE a4 ZIP OWNER PHONE: 36 i3c{g - Z--S;-63 7OWNER EMAIL: CONTRACTOR NAME: wl /c /).0 117 27C, CONTRACTOR ADDRESS: STREET 7 r`� �,.� 13 CITY - 1414 r S L, �. STATE W'- ZIP ZC7 CONTRACTOR PHONE: 3(Gp (Oj( -?fob 1CONTRACTOR EMAIL: u°.v.ln ,AEPS .C.0,11 CONTRACTOR LICENSE#(REQUIRED): /-�N12E,k77-/ 11.7- I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER II CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: K,2^ A&6/,A- CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ 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: I nS�<<(� I GAS ��Y.��c .} Sfz7uZ C,�S Z�•-v LIz.,,� .ccc �..tP(S�C 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 X Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Z 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 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. l City of Everett Official Use Only PERMIT# W I I n — �