4116 GRAND AVE 2018-05-01 - Laserfiche WebLink

PERMIT/�PPLICATIOf� �UILDING / MECHANICAL/ PLUIVIBING /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� www.everettwa.gov/permits (Blue or�lack Ink Only Please) PROJECT SITE IN�OItMAT10N OJECT SITE ADDRESS: ` PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION NER NAME: � �/ TENANT NAME(If Commercial): OWNER MAILWG ADDRESS: sTRee-r � CITY " STATE ZIP OUVNER PHONE: OWNER EMAIL: CONTRACTOR NAME: � CONTRACTOR ADDRESS: s-rReeT CITY 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 PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolifion ❑Change of Use DESCRIPTION OF WORK: �' � ��,�-�1'� � � Y��,R�� U �i�J�' � ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBIN PERMIT APPLICiAT10N Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn Alteration Repair #of List of Fixtures #�f Lisf of Fixtures #�f List of Fixfures #°f List of Fixtures Fi�ctures Fixtures Fi�ctures 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 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 wrifing from the Building Official before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this properfy to pertorm the work for which application is made, and I comply with fhe State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Offrcial Use Only � ` �`/�C'�M PERMI� � Owner/Authorized t Signature Date (Revised 9/23/2016)