2009 122ND PL SE 2018-02-27 - Laserfiche WebLink

477- PERMIT APPLICATIOF BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: C )9 122 ci 17 5 PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) y CONTACT INFORMATION OWNER NAME: Ly\t_ LA GICit c,, TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET C) /2Z/IJ pl SG CITY 6V V c--44- STATE LJ/ ZIP /E'Zc.) OWNER PHONE: 2.- - 3 5U - UR-/-3- OWNER EMAIL: L- (I N 6e--L.e_.-40,14,,/, Conn CONTRACTOR NAME: It \2v"'� It-1-•c-� 42l (l 4 CONTRACTOR ADDRESS: STREET 1-133"I_ J7 ei c. lI- [�c h 12.-C) 7 CITY 1.0.(,^,k t• (4 C.._ STATE //' ZIP q�L CONTRACTOR PHONE: Lac- '--- i- ZZ7Z.. CONTRACTOR EMAIL: 1rt/+l•3 L„ t( A);AIsh.c.... t• C.e n-,. CONTRACTOR LICENSE#(REQUIRED):,4Lt pop 4 /O 0: - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0/VC:6s- PRIMARY CONTACT: ❑OWNER I CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME:, j CONTACT PHONE: 41....<-- d7 S--y- ZZ 7 Z L.��rl� LCa,vl.� Q.rz1 CONTACT EMAIL: 'ti'tL. �4-tt po -f Y`- t.e.. „Irn. cc vrt BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ I -�v• w Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures 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 I 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 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# 6/Zi -- Vtil, ('1 ©& -1)1(o Owner/Authorized Agent Signature Date (Revised 9/23/2016)