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10022 12TH AVE SE 2017-01-18
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10022 12TH AVE SE 2017-01-18
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Last modified
1/18/2017 12:14:06 PM
Creation date
1/18/2017 12:14:04 PM
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Address Document
Street Name
12TH AVE SE
Street Number
10022
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PERMITAPPLICATIO" Publ.,rcGOo✓ice Pe v6 I! <br /> B i ,,' _ _ `, .,. _ , - 'I:_—_e r .. I 1 • -e N <br /> ioe:,___,...A__., <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (c-X%2-1 12-ft. ht ve_ c, '1-7PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i(A \w `v C) Ivy u 0 {rl ( G-1 C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / 0 G 22 ,2 -r1/1AVe 3 E <br /> CITY Q N- 4 If STATE W �-,ZIIP, g� oy <br /> OWNER PHONE: ... 4.75 — 53O - 17.10. OWNER EMAIL:.... -TO l a uI rlr') I v I�` <br /> e 1 I I° ► , RI I, C On/Th <br /> .... <br /> CONTRACTOR NAME: -e -('-)W A-e c <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQ RED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: WNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,'--I2 5i)__ .5-3o —q-7/0 <br /> CONTACT EMAIL: I J (U rut n t7 l w C ( i'r 0 r)'vk oi i I ,C c Yi—n <br /> BUILDING PERMIT APPLICATION <br /> F►U'o <br /> Existing Use of Building: 4)-k ( „ c ` e � 1"c0"'1 D Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHAiNlyeAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> 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 <br /> 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 <br /> Building fficial before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/ ply with the State Contr. tors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# _ <br /> Vkil 160 <br /> Own`cfr/Authorized Agent Signature Date (Revised 5/20/0 <br />
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