1411 KOSSUTH AVE 2017-08-01 - Laserfiche WebLink

PERIl�IT'APPLICATIORI �IJIL.DfIVG / IVIECFiANICAL / Q'LUtVlBIR1C� / SIGN / SPRf�I�CLER I D�iVl0�.11"IOIV CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits (�lue oa� �lack Ink Only �lease) �R�JE�T SITE G(dF�l�MATIi,P� PROJECT SITE ADDRESS: � 4� JT AV� PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) COtdTACT 9FIF0�2NdA"rIONI OWNER NAME: u �/p m � TENANT YVAME(If Commercial): OWNER MAILING ADDRESS: srREEr � Kb $ /� l�L� CITY � � STATE �I�' ZIP q S Z� � OWNER PHONE: Zs•- - (G OWIVER EMAIL: �� e � CONTRACTOR NAME; � F CONTRACTOR ADDRESS: srHe�T CITY STATE LIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVE,RETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify)_ CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of�Vork:$ Proposed Use of Building: Heat Source: ❑C�as ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Uniis: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: \ �1'v(,G lf� �� Th�lFED ) i ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATIOf� PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fi�ctures #�f Lisi of Fixtures #°f Lisi of Fixfures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backfiow 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&Cisposal 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 Chemical or Water No. of Heads ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true anci 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 th��refrom.Deviations must first be authorized in writing from the Building Otficial before being authorized under any circumstance. I am the owner,or I am authorized by the owner of this property to pertorm 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 PERMI �O � � `�� -a3 - � � 1 (o -- Owner/Authorized Agent Signature Date (Revised 9/23/2016)