5214 15TH AVE W 2017-06-07 - Laserfiche WebLink

PERMIT APPLICATION BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov J www.everettwa.gov/permits (Blue or Black ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: Ql ROPERTY TAX#: �2 8 t)'901 00 0,ZyI a) LEGAL for new construction: Short Plat/subdivision _, Lot No. (attach copy or long legal description) CONTACT INFORMATION OWNER NAME: `yQ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ppia j t*� UC &)Q�yyt. {� r;rrr Gll'Pitlt =_;irrF LtJ,�- 2w /<Pao& OWNER PHONE: �o& — 7/3— : '-FQ OWNER EMAIL: N /f1, CONTRACTOR NAME CD+eNR SM/VF /)COF//V C� 1 NC CONTRACTOR ADDRESS: STREET rrry rye TATS- G�� p 9,R)1,�) CONTRACTOR PHONE: CONTRACTOR EMAIL: COR/�E,Pd ��Q[�f�ivG.CCY» CONTRACTOR LICENSE#(REQUIRED): ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D33SG PRIMARY CONTACT: ❑ OWNER Iii<ONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: &ARA 004)"16P, OFOCC mAivf+CJ5R CONTACT EMAIL:_W,4 CDRNCR67-CVV2q xO -ING•rorn BUILDING PERMIT APPLICATION Existing Use of Building: 5 FitContract Price of Work: $ 1 O 7So7.Q Proposed Use of Building Heat Source: ❑Gas ❑Electric ❑Other Building Type. FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-t of Units: ❑Commercial ❑Industrial Type of Project [:]New ❑Addition ❑Remodel C fi} pair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use go—IQ ooi- DESCRIPTION OF WORK: � cas e of" ✓�ca wig- CR 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 AIC—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 JGrease Trap Gas Range Ductinq Dishwasher Roof Drains Clothes Dryer Hookups Other. Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Number 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.I am the owner,or I am authorized by the owner of this property to perforin 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 PERNOIR rrzt>e�t l-7 -2D1 1 q os(4 - Owner Authorized Agent Signature Date (Revised 5/2W2016)