11021 1ST AVE SE 2017-09-06 - Laserfiche WebLink

PERMIT APPLICATION BUILDINGOECHANICAL / PLUMBING / SIGN WRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES OL 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everefteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT SITE ADDRESS- �� I PROPERTY TAX#: D(D 15-0 000 0000 6 QO 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 hz—k l CITY ' ( l 1 STATE C-JA- ZIP ?�� OWNER PHONE: 42 — OWNER EMAIL: CONTRACTOR NAME: JLfZ_ CONTRACTOR ADDRESS- STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR BOTHER(Please Specify) F,--U)L 0 r)(1 CONTACT NAME: CONTACT PHONE: ` -> 1--}S �oa�r1 7aE-G,i CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: )r((1(- F-A/''t U:. ) 1 Contract Price of Work: $ CD, C�)Oc� Proposed Use of Building: FA r`11L` �r''vE_ Heat Source: Gas ❑Electric ❑Other Building Type. ®SSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ZAdditlon El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use DESCRIPTION OF WORK: ADS 70U F. OF tJ vJ QAC t�v2 1 1��vc3 5 a�r Z �P s+uzvo r t S 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 2 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 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 Contractor w 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT#( 9.r/Authorized Age Signature Date (Revised 10/12/2015)