1740 MADISON ST 2017-06-20 - Laserfiche WebLink

PERMIT APPLICATION BUILDING ECHANICAL / PLUMBING / SIGN RINKLER/ 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 (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 7+o Al /' .JDA 1r PROPERTY TAX#: 00545400000502- LEGAL OS454DO0O2LEGAL for new construction: Short Plat/subdivision d)V. 4� Lot No.—,C— 1`Z 4.0r 5 CONTACT INFORMATION OWNER NAME: J�b' /L/t/I,ll�t/ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET /PQ/, �� /23 / CITY le_vhL 771 L STATE �1J ZIP g3ZD6-23,31 OWNER PHONE: ZS -3.51'560 76 OWNER EMAIL: `%A e/1MQn v 7(9 cj/1 c�O,C,D/Lt CONTRACTOR NAME: 0 W Ah�W CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: K OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2,5 -?J 5-6i-56 79) J40-'f /4&-A44N CONTACT EMAIL: J h Gr r l r ren�� . Glh vJ,CJ►vt BUILDING PERMIT APPLICATION Existing Use of Building: IQ Contract Price of Work:$ ZOO Proposed Use of Building: Heat Source: ❑Gas NElectric ❑Other Building Type: SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Go/u'�rRUG1 2 'x (v-5' C6os, � /N �k/S7// - �fJ6 16"12- ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Rep Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of LFixtures #of List of Fixtures #of List of F' tures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Aeat Pump Toilet Backflow Ff6venter(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urin Gas Piping Boiler Lavatory(Wash Basin) Pftking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dry ookups 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.'l 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERM #/ -6 Own /Au rized Agent Signature Date (Revised 5/20/2016)