1210 MADRONA AVE 2017-06-20 - Laserfiche WebLink

PERMIT APPLICATIO BUILDIr MECHANICAL/ PLUMBING /SIGN t L"IRINKLER/ 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 I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: IC) MdI PROPERTY TAX#: LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: M 'A TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREET C e, r,2, -L CITY 'f-7\kq- STATE [,�et ZIP OWNER PHONE: S •^ ,� OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET /�pt ! 1.,-- AA CITY - �I" STATE ZIP CONTRACTOR PHONE: aDG lj4CONTRACTOR EMAIL: ��+ Q L-U yl ke'L+' 6 q t CONTRACTOR LICENSE#(REQUIRED): AQJAL J7 C J?&( q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: d OWNER CONTRACTOR ❑OTHER(Please Specify) C CT NAME``: II-- CONTACT PHONE: 2 O -79q ?3.2 (E, MNX*— !o a k I k&q CONTACT EMAIL: O " fit' BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ SGiO Proposed Use of Building: I Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached RSFR-Attached ❑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: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New_ Addn `I 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 Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains J 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.,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 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 l __ DIt� 771 Owner/ orized Agent Signature Date (Revised 5/20/2016)