2119 MCDOUGALL AVE 2016-10-20 - Laserfiche WebLink

i PERMIT APPLICATI BUILDINV/ MECHANICAL / PLUMBING / SIGN PRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 4*77 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: -?ll 9 m(,J)&'. a.2C PROPERTY TAX#: 00dlO/5"S'`/ 1009 CO LEGAL for new construct on: Short Plat/subdivision 11 U –1 ot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: AAeOAI Wh)L/S TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY �N SA,TF ZIP �e OWNER PHONE: aO(O —�;?6—)— 3 7 fJ OWNER EMAIL: N ,� CONTRACTOR NAME CDieN/ R C] O/VF k)C0F1/\ 6, /NC. CONTRACTOR ADDRESS: STREET l7/}/�2AI /S }}tri, QC pJ�j Q p CITY (�(f! �-� s'TAIt k)A- ZIP IQV/,) CONTRACTOR PHONE: CONTRACTOR EMAIL: C0�21V,FiPcS /�C�f�iVG.0-ar» CONTRACTOR LICENSE#(REQUIRED): COknlp21 gin? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D�3SG PRIMARY CONTACT: ❑OWNER &KONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Xz6_ &ARA COPA116N, 'DF1'/6e "YWVA&JM, CONTACT EMAIL:_WA CpRAJC,4e67-LyyaqQcor/NG.0 BUILDING PERMIT APPLICATION Existing Use of Buildint: Contract Price of Work: $ 1 c3101co Proposed Use of BuildinT K + " Heat Source: []Gas ❑Electric ❑Other_____ Building Type FR-Detachud ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units ❑Commercial ❑Industrial Type of Project. ❑New ❑Addition C?Ze'model ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition El Change of Use DES(�C,RIP�TION OF WORK: �/ ASSOCIATED BUILDING PERMIT#(if applicable), 1 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New Addn _Alteration Repair Type of Project: _New _Addn _Alteration _Repair Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures AIC—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 J I 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 l 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 PER CZID r-A tUAk—A�. -- - '?//(D IL` .. Owner Authorized Agent Signature Date (Revised 5/20/2016)