1617 SILVER LAKE RD 2018-03-09 - Laserfiche WebLink

PERMIT APPLICATION 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 I www.everettwa.gov/permits PROJECT SITE INFORMATION " - - PROJECT SITE ADDRESS: PROPERTY TAX#: fish (V QV- Lk Io( LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Mel v li tri Lf_aa6 tt I1 i4 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET // P./617 7 S) /1/p y^ Lk Rd / �( CrrY tlol ifett STATE u/ 4- ZIP .FF2,v� OWNER PHONE: 14.2-6-- if Ca 7/ 7 OWNER EMAIL: CONTRACTOR NAME: /OW 61 f !!)b 5 (a 11 5 r (/', A CONTRACTOR ADDRESS: STREET 3121 15(rte',// 5 I /V ai cITY ! woad STATE /�t A ZIP Tet/.2- CONTRACTOR PHONE: 1020--.j?Qj1‘,..—(eac) CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): 'TO M. -LI/Cy C 5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER NI CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L125—;C-5-7o3" ow 6 CONTACT EMAIL: BUILDING PERMIT APPLICATION _ Existing Use of Building: Contract Price of Work:$ �b 1200. Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other_ Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: p c-i 1 e S 5 tt Pti votp ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION - Type of Project: .KNew Addn _Alteration Repair Type of Project: _New _Addn Alteration _Repair #of #of #of #of Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 Number 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 with 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 this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# � Li�'J �l-30 1p1Y1 I— toy Owner/Authorized Ag t Signature Date (Revised 10/12/2015)