5404 BROADWAY 2017-05-15 - Laserfiche WebLink

PERMIT APPLICATIOEI i BUILDINWMECHANICAL / PLUMBING / SIGN I bNRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 4a7T 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: 15404 I>RQAQPROPERTY TAX#:O05•QQ(e` OO Z O LEGAL for new construction: Short Plat/subdivision LO W V-L4,, VIf-In.I Lot NoZ� - (attach copy of long legal description) -�-�- CONTACT INFORMATION OWNER NAME: M ICAAEL LQNr6aTENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREEIZ5qby 15 ROAD WA CITY k._+V STATE WA ZIP i V ZD 7j OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: DR46<D 5 F-N LJ tom( pT,, CONTRACTOR ADDRESS: STREET ICD C7C) (J�Q ^ AVE. KI /� CITY N No W p�D STATE W Ar ZIP Q CONTRACTOR PHONE: CONTRACTOR EMAIL: IG, �j {r)n Q�CpWLLGiS'�: het- CONTRACTOR LICENSE#(REQUIRED): NN ''t 4 CITY OF EV ETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 2CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: yf�7 7,14-'7I Z-1 ICR L�j7 Iv �Q �v f a f�/ CONTACT EMAIL: ha hL IVA � • LGYk BUILDING PERMIT APPLICATION Existing Use of Building: Gf�� Contract Price of Work: $ Proposed Use of Building: Heat Source: ❑Gas I ❑Other Building Type: OSFR-Detached ❑SFR-Attached []Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition Wemodel ❑Repair ❑T.i. []Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: CKA"le l aurIAVy v�00 M -v 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 Fi ures Fixtures A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lav ory(Wash Basin) Drinking Fountain Water Heater Refrigeration S wer Floor Drain Gas Fireplace Wood Stove itchen 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.1 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 I 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/'ofEverettOfficial Use Only PE� IT 4 Owner/Authorized get ignature Date (Revised 9/23/2016)