840 N BROADWAY 2017-08-21 - Laserfiche WebLink

• PERMIT APPLICATION 0 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 (Blue or Black Ink Only Please) PROJECT §ITE INFORMATION PROJECT SITE ADDRESS: F�1 O N �j2oA9.,.1�� TAX#: O O S S 1300 00 iq 00 LEGAL for new construction: Short Plat/subdivision Lot No. (attach colay4long legal description) 4TVAt4C'P CONTACT INFORMATION OWNER NAME: -VRvST TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET TWO t4f-viTON ?_1L -455 \AJAS!'1 rJ &-VQ0 1 CITY r'J cw'vc)0 STATE MA zIP p 2 5 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: N CONTRACTOR ADDRESS: STREET CITY /- STATE �(V ZIP CONTRACTOR PHONE: O(O--T HOZ- I 7 Q 0 CONTRACTOR EMAIL: VS t in C en\i.Iro CONTRACTOR LICENSE#(REQUIRED): EN\J\R AA C15 ICITY OF EVERETT BUSINESS LICENSE#(REQUIRE6): PRIMARY CONTACT: ❑ OWNER 000NTRACTOR ❑ OTHER(Please Specify) .y CONTACT NAME: ,vST\ Co�3� CONTACT PHONE: CONTACT EMAIL: 4enviro/-ie .h, "m BUILDING PERMIT APPLICATION Existing Use of Building: �p`11 FXV VU't NV't; Contract Price of Work: $;' Ll 1 2-5 a Proposed Use of Building: `1 C Heat Source: ❑Gas ❑Electric ther }� A�pyM(' Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 06ommercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel RRepair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: PLACC ,E) xxs-m 1 U ( OoL\N (r �� TDw'E(L wt-t-(-f .F02 LIKE Rf'-PL/}CEMIFr`1T, UQ(ra'voe ST9--'1Tv'2- L- AS KEc��tt��R 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 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 Clothes Dryer Hookups y Other: (-OoLrN lr 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.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 au orizqd under any cirCUmstape6. I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and I complywit th State C tra s La 18.27 RC d 296.200A WAC. City of Everett Official Use Only PERMIT# Owner)AIM ori ze d Ment Signature Date (Revised 9/23/2016) V ']