109 113TH ST SE 2018-04-25 - Laserfiche WebLink

PERMIT APPLICATION v�I O BUILDINaECHANICAL/ PLUMBING/SIGN/ =1NK ER/ 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 Biack Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: f � � ,�`J,/ ji 7� � PROPERTY TAX#: LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) CONTAGT INFORMATION OWNER NAME: NAME(If Commercial): OWNER MAILING ADDRES : sTRee-r U � — `�� CITY vAr�� STATE � ZIP �� OWNER PHONE: 7 � � 73 OWNER EMAIL: CONTRACTOR NAME; � �e.'—�U l, U��j\ '� � CONTRACTOR ADDRESS: TRee-r yi',�. CITY � STATE ZIP � CONTRACTOR PHONE: O �j CONTRACTOR EMAIL: — —� CONTRACTOR LICENSE#(REQUIRED): �' C � CITY OF EVERETT BUSINESS LICENSE ~ PRIMARY CONTACT: f$1 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) � CONTACT NAME: CONTACT PHONE: �j�o� �� ��.��e�, CONTACT EMAIL: �� J � J , �� BUILDING PERMIT APPLICATION ' Existing Use of Building: ' ,J'��/ G Contract Price of Work:$ Proposed Use of Building: (�.� Heat Source: Gas ❑Electric ❑O 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: j�J��/�/�G��/�`-`-�,/ >��i��,�c� - ASSOCIATED BUILDING PERMIT#(if ap licable): MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION Type of Project: _New Addn _Alteration Repair Type of Project; _New _Addn _Alteration _Repair �°f List of Fixfures #of List of Fixfures #of u�of Fi�cfures #°f List of Fixtures Fixfures Fixtures Fixtures Fi�ctures 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&Disposai 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.•l 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 circumsfance.I am the owner,or 1 am authorized by the owner of this properfy to perform the work for which application is made, and l comply with the State Contractors Law 98.27 RCW and 296.200A W,4C. City of Everett O�cial Use Only PER IT 'V ti �� - �, Z - � Owner/Authoriz gent Signature Date (Revised 9/23/2016)