13110 19TH AVE SE 2017-09-25 - Laserfiche WebLink

PERMIT APPLICATION BUILD N / MECHANICAL t PLUMBING/SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-881^ ' FAX 425-257-8857 1(E)everetteps@everettwa-gov I www.everettwa gov;permlts 1A TT7712� PROJECT SITE INFORMATION PROJECT SITE ADDRESS: _, i,--7.4, ,._ i, PROPERTY TAX#: ��O �� D01 LEGAL for new construction. Short Ptattsubdivlsion :+J Lot No `3 attach copy of long legal description) CONTACT INFORMATION -7 OWNER NAME: =V ( i� L-t— <- TENANT NAME(If Commercial): W A(,[��N J 7 30 OWNER MAILING ADDRESS: STREET 1j CI Z 1 )i;_ Vl ( ( H rS CITUT I ' �`�1i "1" 041 IP STATE � n Z OWNER PHONE: -71 L" -- 3 J r 4 OWNER EMAIL: -1-tiV� E' 01 /-A c)t, P) til US l -7— CONTRACTOR CONTRACTOR NAME MEArvo WLS�Ud�w CONTRACTOR ADDRESS: STREET IN STATE ZIP CONTRACTOR PHONE: I CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ®OTHER(Please Specify) i'�._`L.'_.nl,i LC-y2 -4NQ'C f"i," CONTACT NAME: CONTACT PHONE: L��J 2-,' 3 �4 i L4 7 I�,JNEtC� Z�GEt�nS�.� CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:S Proposed Use of Building: C t+ Heat Source: ❑Gas lectric ❑Other Building Type ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Familyof of Units ®Commercial ❑Industrial Type of Project ❑New ❑Addition ❑Remodel ❑Re air ❑T.I ®Sign ❑S nnkler ❑Demolition ❑Chan a of Use DESCRIPTION OF WORK: �NTS RFr A C)1- '10,, Cot,,S U)cT TZ.00 M S; , NO Sc.oF c To -F C C >LfC(L(02 6iZ 5i-TC OF TW11:,- -4';(20.1CC7 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 Fixt res AIC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) tJ Forced Air Systems Unit Heater i ',k. Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater , Refrigeration i ;r. Shower Floor Drain Gas Fireplace A 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 P. Sink(Service/BarlMopletc.) Other: SPRINKLER/SUPPRESSION SYSTEM Number of Heads = lU N 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 tical 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 1 comply with the State Con Law 18 27 RCW and 296 2004 WAC. City of Everett Official Use Only 7 '1 PERMIT I Owner/Authorized Agent Signature Date (Revised 1-011212015) �/