2416 ADAMS AVE 2019-01-17 - Laserfiche WebLink

PERMIT APPLICATICa . UILDING /MECHANICAL/ PLUMBING /SIGN I SPRINKLER I DEMOLITION /�f __ CITY OF EVERETT PERMIT SERVICES mow3200 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: (3,4 l (p /i 1060.( g i'U L PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: C_/94.I. Li t./ 0Gtie11,0 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET Z41 to 6 0AvA S eau C V t CITY bit STATE 14./19- ZIP J OWNER PHONE: 4 2S" 3J'j ' 916 OWNER EMAIL: CONTRACTOR NAME: 111,1—W rJ1-17 I LL1#131 i ilk CONTRACTOR ADDRESS: STREET l 00 L GQPI m t vz ,C C J5- 43. I id A p4 r--MI " CITY y. J�+ STATE l/(..�--- ZIP $ f Z 21 CONTRACTOR PHONE:3�Q — 4 2427J 7 �+yO pCONTRACTORy-� EMAIL: CONTRACTOR LICENSE//#(REQUIRED): �rZ.t C 0 e P a 3 • 11CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: WNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: rr�� CONTACT PHONE: 3(420 f r 5 _S 3 �,.�� ?..._.)kdkp.)1/4.6 ?e�'tw CONTACT EMAIL: Jrrt—w -'' , - % N �-u^ `�-- BUILDING PERMIT APPLICATION C� ----- 4 Existing Use of Building: Contract Price of Work: / Proposed Use of Building: Heat Source: OGas •Electric DO Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: •Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ,epair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use � �DESCRIPTION OF WORK: 1.6_6=-7 ajvt /..J t & 910‘,1 e, "og5)0 ".. L l 14.67- i2 L t ICS (1 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 Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range DuctingI washer Roof Drains Clothes Dryer Hookups Other: Clot s Washer Medical Gas Range Hood I Water\Heater Other: Exhaust Fan Sink ervice/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 Contractors Law 18 nd 296.200A WAC. City of Everett Official Use Only PERMIT# ,.....409 Owner/Aut orrzed Agent�ignature Date (Revised 9/23/2016)