5 75TH ST SW 2017-01-13 - Laserfiche WebLink

PERMIT APPLICATIf1N BUILD / MECHANICAL / PLUMBING / SI(:"'" SPRINKLER / 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 CONTACT INFORMATION OWNER NAME: ��/l, � L' TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srr�eer � ��j � , � Iy'(,•� CITY � ��r�� 1 STATE � ZIP � ^ C��' .� OWNER PHONE: `, Z� '.� % S", (p, �.. OWNER EMAIL: !\ �{+1 G� G ii'" �GE; ' �O. E'J G CONTRACTOR NAME, �' r,{�_/ �� GT "1 ' 1'f L� - Gi L %�' l / ` CONTRACTOR ADDRESS: sTReer � � � �/� J 1 , / CITY - �,� � STATE VV ZIP �� l Y CONTRACTOR PHONE: Zfj — Q�' `" � CONTRACTOR EMAIL: `�C�Y1�)1c;tJS� ch) ;" >6-� � CONTRACTOR LICENSE #(REQUIRED): r� �_ �, �`i� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �) �) PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: (.r Z Q '�, ��''� r �� , f' i��i'1 C:�� ti �l; �( f�Wj coNracr Ennai�: �� j � Y, �_ �� BUILDING PERMIT APPLICATION ,�� Existin Use of Buildin ` - ( � 9 g: �;�1 '�� . � ��9L Contract Price of Work: $� , d� Proposed Use of Building: t�% v✓1 -*� Heat Source: ❑Gas lectric ,' ❑Other Building Type: ❑SFR-Detached qrJFR-Attached ❑Duplex ❑Multi-Family-# of Units: �''�Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Cha e of Use DESCRIPTION OF WORK: �'�� ` 1/� ��vl � '�GK�� K (`UC� � l, � ��., ��; .,�- ,n�10 �,�,�� i z� � � 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 Lisf of Fixtures # of List of Fixtures # of List of Fixtures #°f List of Fixtures Fixtures Fixtures Fixtures Fixteres 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: U,� 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 airrent 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. 1 am the owner, or I am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Cont rs Law 18.27 RCW and 296.200A WAC_ ` G� City of Everett Official Use Only � �� C� �� PE T �� . O l �� i Ow,p'crlAutliorized Agent Signature Date (Revised 5/20/2016)