2528 E GRAND AVE 2017-08-10 - Laserfiche WebLink

PERMIT APPLICATI• GUILD& I MECHANICAL I PLUMBING I SIGN I 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 I www.everettwa.gov/permits (Else or Black Ink Only 'lease) PROJECT SITE IN FORMLaTUON PROJECT SITE ADDRESS: PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION _ OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET JA 4 1�-?VkT CITY .(/ �' J STATE &-1114 ZIP OWNER PHONE: 2)`T .-1 z 5- OWNER EMAIL: �� "�(,) �,� CONTRACTOR NAME: /lI CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: gtOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: "r- ,L r X CONTACT EMAIL: 44 BUILDING PERMIT APPLICATION Existing Use of Building: Ak5,,aew�F L Contract Price of Work:$ Proposed Use of Building: n-Ig - Heat Source: ' Gas []Electric []Other Building Type: SFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition EIRemodel XRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: /l7� �Al 7-"V771-4`- Jtd p p'K a /��-/ `ar�2 t�/ XN�4 cc S; y'tr'Y�YT /�R etc ,3y4 SBntcr r AD /'i-rr/1� i7�'r iN' 41X22 5 iAJ �'�5�:��U;. �i.J.;c�S i �/Z q ��u i✓�� t�,t,,odY� s�ti'�+ls ��,� &EAU '7-a. �W4iA,/. 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 A 711 G Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler J 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 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./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 locallaw.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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and 1 co ly wi7 he State Contra 18.27 RCW and 296.200A WAC. �--� City of Everett Official Use Only PERMIT O r Authoriz d Agent Signature Date (Revised 512.012016)