2703 12TH ST 2018-05-02 - Laserfiche WebLink

� I IIII PERMII'APPLICATIONIIIIII BUILDIN�TIQIECHANICAL/ PLUMBING /StGN /�PRINKLER/ 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 Black ink Oniy Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 2,�-Q3 ' �� PROPERTY TAX#: �90 S�J�D��O��O� LEGAL for new construction: Short Platlsubdivision Lot Na (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: �,j�ifZ�� Qvs� (�s �} . TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTrteET d 'q � � o�-� � �'v�� CIT' ��G�� STATE W�� ZIP Ly� OWNER PHONE: �1� �� W1,1��-L� OWNER EMAIL: ��-e��Qv��-' CONTRACTOR NAME; T�.�, � CONTRACTOR ADDRESS: sTREer 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: �Z5'— 2�i'3 -. .� b 1 T� ��- �� F � CONTACT EMAIL: ,� � � .o�.i/ � , � BUILDING PERMIT APPLICATION Existing Use of Building: ��rJ "�'S' Contract Price of Work:$ � (� ? U Proposed Use of Building: Si�-t�v�� Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Muiti-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ��j��{j rQQ � �.r(/�=�Z(o� (, �l�f/1-7it1.�-j-t ASSOCIATED BUILDING PERMIT# if a plicable): MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn _Alteration Repair #of Vy�of Fixtures #of Ust of Fixtures #of Cist of Fi�ctures #°f List of Fixtures Fixtures Fixtures Fixfures 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.�!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 locallaw. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building O�cia/before being authorized under any circumstance.1 am the owner,or 1 am authaized by the owner of fhis property fo perform the work for which application is made, and I comply wifh the State Contractors Law 98.27 RCW and 296.200A W,4C. City of Everetf O�cial Use Only _ S �_ � � PERMIT#��D� ��j V Owner/Authorized Agent Signature Date (Revised 9/23/2016) `�