1410 119TH PL SE 2017-03-13 - Laserfiche WebLink

PERMIT APPLICATION /111144%* :::4 BUILDING / MECHANICAL I PLUMBING /SIGN /SPRINKLER / DEMOLITION sitligCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)evsretteps@everettwa.gov i wuw.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT SITE ADDRESS:", 1O 7, PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description; CONTACT INFORMATION OWNER NAME: is H,C4$4 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET /'J/ /19 '``N._ CITY p\.,lz,,f .1 STATE ?r.dA7 ZIP }` v OWNER PHONE: -. a4 ,2Vj,m( 8 e OWNER EMAIL: CONTRACTOR NAME: 4 ly?Estj� ,, 3-7-41,4, ,Q 7.6 ya i,s S' ...mss CONTRACTOR ADDRESS: STREET,,2 yj}j �77 1 ''� t-.J CITY ,L)2.i G STATE ZIP 9 +,0 36 CONTRACTOR PHONE: y.2 gt€r_S-- /O Co / CONTRACTOR EMAIL: /t4.14YP.1AyyfU,,, 4•t5r gP,Lur•l / 0. I CONTRACTOR LICENSE#(REQUIRED):4py1 �6, 87/P„/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):6 S-/ / PRIMARY CONTACT: MOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 5 .,, 2,i4Orke/ .- CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ Proposed Use of Building: Heat Source: ❑Gas ©Electric CI Other Building Type: I:SFR-Detached DSFR-Attached DDuplex DMulti-Family-#of Units: ©Commercial [Industrial Type of Project: ONew ❑Addition DRemodel DRepair DT.l, DSign ©Sprinkler ©Demolition ©Change of Use DESCRIPTION OF WORK: R cA, +!64,14,A,)4, : / �. etr s... X64- o 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 Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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/Ber/Mop/etc.) Other: ' SPRINKLER/SUPPRESSION SYSTEM !Number of Heads a 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 1 am authorized by the owner of this property to perform the work for which apolcation is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 'PLEA,E LAR. r0A- i:IAl *'7 Ya Yd g- i 06! PERMIT# ^y/ r) -'(---7--; 1 ,. 7-- 06-109h& /kit- ((1)6 S D Owner/Authorized Agent Signature Date (Revised 10/12/2015)