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2615 BROADWAY QFC 2017-10-03
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2615 BROADWAY QFC 2017-10-03
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Last modified
10/3/2017 10:26:17 AM
Creation date
10/3/2017 10:26:14 AM
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Address Document
Street Name
BROADWAY
Street Number
2615
Tenant Name
QFC
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PER11IT APPLICAT10,6 <br /> EUILDA MECHANICAL/ PLUMBING /SIGN I �PRNKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue.or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: JCOp 5 f�)VC�a1 � PROPERTY TAX#: 0 " 3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: GIT InL. TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Q �nst <br /> o <br /> CITY U \ STATE "�' ZIP 14 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Ra— <br /> CONTRACTOR <br /> ADDRESS: STREET P <br /> CITY mO� STATE /V0, ZIP 5D- <br /> CONTRACTOR PHONE: �� — e �, � CONTRACTOR EMAIL: `� � �� — <br /> cc M <br /> CONTRACTOR LICENSE#(REQUIRED): R R.EMCES CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Q q a9 <br /> PRIMARY CONTACT: ❑OWNER X CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 4 � CONTACT PHONE: 'A'a , <br /> ' CONTACT EMAIL: CO�-���, COV' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 5000 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: SCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel RRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Re-mOVe C,0YVt!'ZA_ `ROr\ <br /> %eco y, ��nt�VX6 r-ep oc'co- oJ�A-h r "--w Pr)�v1 Rkoa 5�s�rn o r"d <br /> 'ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION[ <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other:aj Clothes Washer Medical Gas <br /> Range Hood m Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Y1oz.Z 2.S <br /> 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 <br /> 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 <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made. <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1!! <br /> IT#Y� <br /> 5// <br /> cv <br /> Owner/Authorized Age t Signature Da (Revised 5/20/2016) '\1. <br /> Z <br />
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