10303 19TH AVE SE 2017-09-25 - Laserfiche WebLink

PERMIT APPLICATION BUILDING / MECHANICAL/PLUMBING /SIGN / SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everetwm.gov I www.everettwa.gov/permits (Blue or Black Ink only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1 l CS G PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: --IPATENANT NAME(if Commerciaij; a./M' OWNER MAILING ADDRESS: STREET�9 310 L 'S CITY STATE Zip LV Wj OWNER PHONE: Z 773 79&5 1OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET L416 Q CITY STATE V /k ZIP CONTRACTOR PHONE: 15 r) CONTRACTOR EMAIL: d�l� i d)C*'r1P -eCLW1 com CONTRACTOR LICENSE#(REQUIRED):U► 1lilta rot B-7Zd rl CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (rt PRIMARY CONTACT: ❑OWNER §d CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: Q CONTACT PHONE: C� 01aF6 CONTACT EMAiL' + YJI C1 YtP ?t1 �0(yl 13UILUING PERMIT APPLiCATION Existing Use of Building: lContract Price of Work:S Z Proposed Use of Building: Heat Source:_ )(Gas ❑Electric ❑Other BuildIn T pe. ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: xCommercial ❑Industrial T pe of Project: ❑New ❑Addition ❑Remodel 1&epair ❑T.I. ❑Sin ❑S rinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Ref i ate. Jo's r K Com, 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 #of #of Fixtures List of Fixtures List of Fixtures #of List of Fixtures List of 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 Refrigeratlon Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ductinp Dishwasher Roof Drains Clothes Dryer Hooku s 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:/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.Deviationsmust first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, and l comply with the Stato Contractors Law 18.27 RCW and 296.200A WAC. PEM�^� l City of Everett Official Use C?nty Owns/Authorized Agen ignature Date (Devi,ad 919,V2016)