412 LAUREL DR 2018-07-18 - Laserfiche WebLink

OlerrPERMIT APPLICATIONBUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 170,2 2.04--k€Q n,e PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: K A �le K' TENANT NAME(If Commercial): OWNER MAILING ADDRESS:©©© STREET '//2 2 p,,,et.,Q A A CITY EI/EkE,14VI STATE 2.,C11/- ZIP 'f J'c L& 1 OWNER PHONE: -1-4,2,-S'-a(rQ 71 y0 OWNER EMAIL: .6- B Zt1 .i (' S',f}, &Al CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION l f Existing Use of Building: ///L I�neiRy gg t`L2 J1Contract Price of Work:$ 'T � � Proposed Use of Building: 2L:1-441 cs i 7 1 f Heat Source: Era as ❑Electric ❑Other Building Type: ❑SFR-Detached SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial 0 Industrial Type of Project: ❑New ❑Addition L 2emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIP ION OF it / a lv � Q rr...0406`f _%:a iA ��/'l�Cf 4 6 5k wiry tl bAnrA ,J8 A�Js ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn ,'Alteration Repair Type of Project: New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures,. Fixtures A/C-Air Handling Units Heat Pump / 'Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater / Bathtub Urinal Gas Piping Boiler .Z 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 I 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 writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contrac v s Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only .0 P E law 4...v, '7-.2/- i 7 \ (. • . orized Agent Signature Date (Revised 9/23/2016)