1601 COLBY AVE 2017-05-23 - Laserfiche WebLink

PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES OL 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 (Blueor Black Ink C3nly Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: UCJ PROPERTY TAX M LEGAL for new construction: Short PlaUsubdivisron Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME; TENANT NAME(If Commercial), OWNER MAILING ADDRESS: STREET IUD l Crn STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: HCA—W& CONTRACTOR ADDRESS: STREET L41 Q CITY STATE V v ZIP „ .,+' CONTRACTOR PHONE: a63 d, CONTRACTOR EMAIL: e t+O Ylvi eol.'�`A coli CONTRACTOR LICENSE(#(REQUIRED):CM( TM l,�i`26-71L)('i CITY OF EVERETT BUSINESS LICENSE#(REQUtRED): I p t PRIMARY CONTACT: ❑OWNER 14 CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAMES 1CONTACT PHONE:M-ct � 9t ,41 CONTACT EMAIL: I C.1h�n et In M BUILDING PERMIT APPLICATION' Existing Use of Building: Contract Price of Work:$ 0O - Proposed Use of Building: Heat Source: as ❑Electric ❑Other Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑lndustrlal Type of Project: ❑New ❑Addition []Remodel_ Repair [IT.]. ❑Sin ❑S rinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 1-�e�10-ce, CSF ASSOCIATED BUILDING PERMIT#(if applioabley MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New _ Addn _Alteration _Repair Type of Project: New Addn Alteration Repair #of #of — — List of Fixtures 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 Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ductinq Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink Service/Bar/Mopletc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or W I No.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 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.t am the owner,or t 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 of Everett Official Use Only PERMIT# I �01b r ! 'Owner/Authorized Agent Signature Date (Revised 12312016)