5021 W HIGHLAND RD 2018-05-29 - Laserfiche WebLink

� PERMIT APPLICATIO� 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 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: p o2.� •�� ,q,� PROPERTY TAX#: Od'��{ZZ.Do 00?-Cc O O LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 3(1t.2O1� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer Cj O o2 5� � CITY E V�r-{Z�.� STATE v" " ZIP `g�� OWNER PHONE: .-7 `. q a y� OWNER EMAIL: CONTRACTOR NAME; 1�FiC{L�120 CONTRACTORADDRESS: srneeT ��j�lb �1�� 17}� �L �'-�—] CITY ��1��I�v V�L��j STATE dV� ZIP �O��2.. CONTRACTOR PHONE: ?-�(p • "7$'(P � � q D�.,. CONTRACTOR EMAIL• d �0 �.�-CK-� CO '�`, CONTRACTOR LICENSE#(REQUIRED): � �K{�� CITY OF EVERETT BUSINESS LICENSE#(REQU ): ' PRIMARY CONTACT: ❑OWNER Q'�CONTRACTOR ❑OTHER(Please Specify) n CONTACT NAME: CONTACT PHONE: jp�, -I g� , �q p� �� '�'�'�� CONTACT EMAI�: G�C ro r G�.2GILS Co rrL �- BUILDING PERMIT APPLICATION Existing Use of Building: � Contract Price of Work: $ D • Ov Proposed Use of Building: �o C,1nu,w Heat Source: ❑Gas ❑Electric ❑Other � Building Type: ❑SFR-Detached ❑SFR-Attached �Duplex ❑Muiti-Famil -#of Units: ❑Commercial ❑Industrial T e of Proect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use DESCRIPTION OF WORK: _ +��.�..�l �, ��c.�s�-��n.5 � - 1��i�e, {-�,- I� I�-e� C ��f� �� ASSOCIATED BUILDING PERMIT# if a licable : MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New Addn Alteration Repair Type of Project: New Addn Alteration Repair #of tist of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixiures Fixtures Fixtures Fixtures A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Firepiace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ductin Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Ran e Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc. Other: SPRINKLER/SUPPRESSION SYSTEM Chemica�or Water No.of Heads ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply wiih 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 Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of fhis property to per(orm the work for which application is made, and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# � �o �� —C � Owner rized Agent Signature Date (Revised 9/23/2016) t( �{�