5019 COLBY AVE 2018-05-01 - Laserfiche WebLink

_II PERMIT APPLICATIOI�" �UILDINI��ECHANIC,4L/ PLUM�ING /SIGN � ��RINKLER/DEtVIOLITION 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�lack Ink Only Pleas�) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:j� �5 �Je(� � �S ZO PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivisio Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: �qV�� TENANT NAME(If Commercial): OWNER MAILWG ADDRESS: sTReer �O� �j �j � CIIY STATE ZIP g�[-EJ OWNER PHONE: L� — ZZ— OWNER EMAIL: c� SG�1 t.c E/`�Lt,� c'i�04'i CO� CONTRACTOR NAME: ,j�L� CONTRACTOR ADDRESS: sTREer CIN STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMITAPPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: I�FR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Family�#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ��Ge �� \� u �(�q v,e� � ,� du� , ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICi1T10N Type of Project: _New Addn Aiteration Repair Type of Project: _New Addn _Alteration _Repair #of List of Fixtures #�f List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixfures A/C—Air Handiing Units Heat Pump Toilet Backflow Preventer(Inside Bidg) 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.•I have reviewed this application and confrrm the information confained herein is true and correcf.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.1 am the owner,or l am authorized by fhe 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# � � � cg -�zl Owner/Authorize Agent Signature Date (Revised 9/23/2016)