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116 E INTERCITY AVE 2018-05-21
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116 E INTERCITY AVE 2018-05-21
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Last modified
5/21/2018 11:07:34 AM
Creation date
5/21/2018 11:07:28 AM
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Address Document
Street Name
E INTERCITY AVE
Street Number
116
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PERMIT APPLICATIO�� •• <br /> BUILDINt� � IVIECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Oniy Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS;' � - , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � TENANT NAME(If Commercial): <br /> ..�- <br /> OWNER MAILING ADDRESS: sTRE r � <br /> r _ O ' <br /> CIN� STATE 2, ZIP � <br /> OWNER PHONE:N�� -�� - � � � OWNER EMAIL:� , `' 1 (� �i I'1Q� . '' �;Yv'1 <br /> CONTRACTOR NAME, - 1 � � i L� \ <br /> CONTRACTOR ADDRESS: cu��r�� � # C,1 <br /> CITY .�� STATE �'��'�,. ZIP <br /> L . '` CONTRACTOR EMAIL: ���� `� ` <br /> CONTRACTOR PHONE: ��-�`�1 • v " �'v Z'W+�''�i'�-� <L� �i <br /> j^�z(a,a�jh u <br /> CONTRACTOR LICENSE#(REQUIRED): ' �(��Z'�}'� CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : I 2�Z�+i�1 <br /> _ _ _ __ _ <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: • � <br /> ``�S� ��5 G <br /> ��,� -���� � CONTACT EMAIL: n� ��� i ��':� . ',� t�'C 'Y�i • L,G f�'` <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$_ . � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �-�1��. ����. p�� � �p��. ,�� .�c�.�� ��c,�ti <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures ��f List of Fixtures #of List of Fixtures #°f List of Fi�ctures <br /> Fixtures Fixtures Fixtures Fi�cfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informafion contained herein is true and correcf. Work done pursuant to this permit must comply with <br /> currenf 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 <br /> Building Official before being authorized under any circumsfance. I am the owner,or I am authorized by the owner of tliis property to pertorm the work for which application is made, <br /> I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officral Use Only <br /> PERMIT# . <br /> ' --- �1--� -�i;� � L� � � bd� <br /> Owner/A horized Agent Signature Date (Revised 5/20/2016) <br /> �l� <br />
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