2719 12TH ST 2018-04-17 - Laserfiche WebLink

PERMIT APPLICAT'IOM• BUILDING�ECHANICAL/ PLUMBIRIG /SIGN / SPRINl�LER/ 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) P6tOJECT SIYE iWFORMATIOM PROJECT SITE ADDRESS: �Z�� Z '� S� PROPERTY TAX#: Z GIQ SI�OU f O;3 LOl� LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) COIdTACY IPIFORMATIOib OWNER NAME: �� ,7�� , ��;, ��}-} , TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srReEr �j �j �'L CIiY �v G��G STATE W� ZIP � c L�1 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: T�� CONTRACTOR ADDRESS: srReer CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETi'BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �z j- 2�`�3 -. 5 b I T�K� ��''��- �-?�4-r,� � �y'—'�j� CONTACT EMAIL ,��-� , � � t� � � , � BUILDING PERMIT APPLICATION Existing Use of Building: �M�e-� '}S Contract Price of Work:$ � � U�% Proposed Use of Building: �fj-rv��. Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family�#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ' CIv� l,�lvti�L ��. � � � � J �✓ ,, l. ASSOCIATED BUILDING PERMIT#(if applicable): �J�,,,-,1 v.r -�P.,,r-i �3_r y��o � r j��y�� MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair Fi�ctures List of Fixtures Fixiures List of Fixtures #°f List of Fixfures #°f List of Fixtures Fixtu�es Fixtures A!C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace 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 Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water No. of Heads ACKNOWLEDGEMENT.�/have revrewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comp/y with current federal,state,and local law. The granting of a permit only aufhonzes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building O�cial before being authorized unde�any circumstance.1 am the owner,or I am authorized by the owner of this property fo pertorm the work for which applrcation is made, and I comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. City of EvereB O�cial Use Only ` s �4 � � PERII�T�-� �-- . � . �c 1=•. .,.. e r � r � '� �v' - :J `i t J Owner/Authorized Agent Signature Date (Revised 9/23/2016J � ' C—_