1209 EVERETT AVE 2017-04-11 - Laserfiche WebLink

PERMIT APPLICATION BUILDINC ECHANICAL / PLUMBING / SIGN = 'RINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVI(,L3 OL 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 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: 209 Eve�e U.e ).Q(/ PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) 1 CONTACT INFORMATION OWNER NAME: \L l �,C� r TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET _2( 5Q- CITY 1./.Q� STATE WA ZIP U OWNER PHONE: 4-2 ":20G& rj OWNER EMAIL: c z( CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: WNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4ZC2 . �l�v, -fCONTACT EMAIL: BUILDING PERMIT APPLICATION /�/ �/ Existing Use of Building: > Contract Price of Work: $ " 5-Do x Proposed Use of Building: C,. Heat Source: Gas lectric []Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel JX,Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Remb�/t' f R-eca-.Fz- ?-Cd 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 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater I 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 ACKNOWLEDGEMENT:/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 tinder any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and l comply with the State Contractors Law a 296.20 City of Everett Official Use Only PERMIT# Owner Auth Ized Agent Signature Date (Revised 5/20/2016)