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1006 COLBY AVE 2017-10-04
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1006 COLBY AVE 2017-10-04
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Last modified
10/4/2017 10:55:34 AM
Creation date
10/4/2017 10:55:33 AM
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Address Document
Street Name
COLBY AVE
Street Number
1006
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0 PERMIT APPLICATION 10 <br /> BUILDING I MECHANICAL I PLUMBING I SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 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: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/S.bdivisi.n t Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: M L4=2,; W'4,WV-L�S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 00(� o �UL✓3V i 1 VL <br /> CITY � ���- STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET 14 ! MA <br /> CITY STATE Z- <br /> CONTRACTOR PHONE: S`c$g j 3 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): WOWIT I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER WrCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L f'�L 3�D -7 co(4 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: I Contract Price of Work:$ SCX> <br /> Proposed Use of Building: Heat Source: fdGas ❑Electric ❑Other <br /> Building Type: JFJSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition 0'emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ^ <br /> �Z L-Vt'S <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: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water INo. of Heads <br /> ACKNOWLEDGEMENT.'/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./am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> '9112-117 PERMIT#,i ` ( I + � �� <br /> Owner/Authorized AgentSignatureDate (Revised 912V,/311_200.16) <br />
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