1922 112TH ST SW 2018-06-12 - Laserfiche WebLink

PERMIT APPLICATION BUILDING/ MECHANICAL/PLUMBING/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 (Biue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: i Y Z Z �IZ� Sr ,S L..%kllL%'r�� PROPERTY TAX#:(�� C LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: � � G�(.J l TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srnEer J C� Z,.� � � cm y�h � STATE� � ZIP /�L7 OWNER PHONE: 4 ZS ,��/ Z� OWNER EMAIL: C % � � � c�.�(� �� C� CONTRACTOR NAME: - CONTRACTOR ADDRESS_ sTaeer CITV STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE J�(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: �1 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: S`t;,� � - (�� i � CONTACT EMAIL: S,�,.,,C � � q h c.�Z BUILDING PERMIT APPLICATION �^ �, Existing Use of Buildin : Contract Price of Work:$ : Z'� cr� � Proposed Use of Building: Heat Source: �Gas DElectric Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑ mmercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler dt�e ion ❑Change of Use DESCRIPTION OF WORK: ��r �--� ��ss 1 ;��.� k�f y��s h�k��' ASSOCIATED BUILDING PERMIT# if ap licable: MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New Addn _Alteration Repair Type of Project: New Addn Alteration Repair #of List of Fixtures #�f List of Fixtures #�f List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures F/xtures A/C—Air Handlin 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 8�Disposaf 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:1 have reviewed this application and confirm the information contained herein is true and correct.Work done puisuant to this permit must comply with current federal,state,and loca/law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifing irom the 8uilding O�cial before being authorized under any circumstance./am the owne�or I am authorized by the owner of this propeRy to perform the work for which application is made, and 1 comply with the State Contractors Law i8.27 RCW and 296.200A WAC. � Ciry of Everett O�cial Use Only PE IT G � 2� �� - � z - �.�� '�. �� l — U�-lfo wner/Authorized Agent Signature Date (Revised 9/23/2016)