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1725 MAPLE ST 2017-10-24
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1725 MAPLE ST 2017-10-24
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Last modified
10/24/2017 10:43:34 AM
Creation date
10/24/2017 10:43:32 AM
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Address Document
Street Name
MAPLE ST
Street Number
1725
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• PERMIT APPLICATION* <br /> BUILDING / MECHANIC %PLUM IGN / SPRINKLER/ DEMOLITION <br /> CITY O E2Nt1 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: 112 Z' (� '� �Q-Q t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ^vit A k( A, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j Zrj {<< <br /> CITY V` (� STATE 71P <br /> OWNER PHONE: 42S LSA 1OWNER EMAIL: <br /> CONTRACTOR NAME: \�rr L <br /> CONTRACTOR ADDRESS: STREET S A 10NS� <br /> CITY00 "- STATE zip / <br /> CONTRACTOR PHONE: TZ-5 -�;30—(Zo22 U I CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): I<? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0 2 �I <br /> PRIMARY CONTACT: ❑OWNER 9CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Q s la Contract Price of Work:$ 12,,Cy-)s, <br /> Proposed Use of Building: Heat Source: ❑Gas 210Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition JKRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> x DESCRIPTION OF WORK: 1 <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 i lKitchen 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 I I No. 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.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI # <br /> _ _ _ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />
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