919 105TH PL SE 2018-06-12 - Laserfiche WebLink

PERMIT APPLICATION BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKL / Q� CITY OF EVERETT PERMIT SERVICES ��V I�L 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov� www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1 Q�-� L PROPERTY TAX#: LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: � TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer `q l � CITY LU 1 STATE ZIP Z� OWNER PHONE:� � " -' OWNER EMAIL:J Q � )Q. CONTRACTOR NAME: U I� CONTRACTOR ADDRESS: sTaeer Q CITY �. � I STATE � ZIP CONTRACTOR PHONE: Z�� - I CONTRACTOR EMAIL: n e CONTRACTOR LICENSE#(REQUIRED): — r � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: 1 CONTACT PHONE: LI'��- I - � � (jI �� CONTACT EMAIL: � BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ,�Gas ❑Electric ❑Other Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: �1� a�G� k��n d ��aC-e CV�fr� -� OC� 9 ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New Addn _Alteratio epair Type of Project: New _Addn _Alteration Repair #of List of Fixtures #�f List oi Fixiures #°� List of Fixtures #°f List of Fixtures Fixtures Fixiures Fixtures 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 Number of Heads ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct. Work done pu�suant to ihis permit must comply with curreni federal,state,and local law.The graniing of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being autho�ized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform ihe work for which application is made, and 1 comply with the State Contracto�s Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERM T# l�1a�� I Owner/ 4h ized A en gnatu Date (Revised 10/12/2015)