5829 S 2ND AVE 2018-03-27 - Laserfiche WebLink

PERMIT APPLICATION • BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES ell5/LIIP 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits ', se;t S. ...i t E4C * $$ ORM f Mme.. =f.., PROJECT SITE ADDRESS:00249 5 2 "'fir PROPERTY TAX#: ZBO.Se 51%2317--54C)Z5 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) OWNER NAME: V-1-te �' '—' - TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5.00.9 te " ��C( �l CITY STATE A- ZIP nn( 7 OWNER PHONE: '^[Z'J� el 21- OWNER EMAIL: CONTRACTOR NAME: 4V VU 04-- --4 '0 --1,14./010i- 1.---- CONTRACTOR -1 \� -L • CONTRACTOR ADDRESS: STREET I Jf'4 1 4 ,A9 I r-lvv ` I r� �w t,, CITY 5 w�1�Y✓" A, STATE 1✓kI PS- ZIP �g 2'9`F' CONTRACTOR PHONE: 3 top k g) 0 tQ,9 CONTRACTOR EMAIL: V-I""t QM,Q'gyp •CC) CONTRACTOR LICENSE#(REQUIRED) ,_1 -‘,1i0 Cj U iCtQ 0 Sola t2•3" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 55j.!` 9 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4-16 +21— 14 I ✓(:;i .e-1-' 17-42--1- t/`` ''{t L.L CONTACT EMAIL: H-v3vt&.' • l• ^ t i `fit f 00,ILj. N `0 P A !frau, 1 Vis.` Existing Use of Building: Contract Price of Work:$ 11 tX:7O. OE> n^ 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 Aildition CI Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition El Change of Use DESCRIPTION OF WORK: 9 LAO I e,-V.DAZtot rrt) . -11sJhl-9. ----. ASSOCIATED BUILDING PERMIT#(if applicable): p Type of Project: _New Addn Alteration _.,Repair Type of Project: _New _Addn Alteration _Repair #ofList 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: 'Chemical or Water I INo.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 wit the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only vid�A j � � QQ 111-11 14— PERMIT#0r1oS -'d3-7 Owner/Authorize Agent Signature Date (Revised 9/23/2016) g