2401 BROADWAY 2019-01-17 - Laserfiche WebLink

PERMIT APPLICATION BUILDING�CHANICAL/PLUMBING/SIGN MF=hINKLER/DEMOLITION I74 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 (B! ►parr Nla c`nkoi+l�►, F` ieaa ) ; PROJECT SITE INFORNIATJON , PROJECT SITE ADDRESS: 2j-C) I 13 CO -4C)VIJ 11-51 PROPERTY TAX#: a CL371 Si-f40 o to o LEGAL for new construction: Short Plat/subdivision EVE12E11"PLAT-OPbUC''' YLT Io. r 2—(attach copy of long legal description) ,$et.-S4,t4-17:19 CONTACT'INFORMATION , OWNER NAME: a.l1 O I (v fLO4IO WAL( /^I.-L TENANT NAME(If Commercial): TIM 5 at/� s(-1 I OWNER MAILING ADDRESS: STREET I Lf g AA-P1-6_,Vtiv- 3I,L l"(Z j .,1 /� ¢ cry 1'1)Q f10141,15Y{ STATE W A ' ZIP 8r2 (p O OWNER PHONE: 10(r •'4-1• 22.01tOWNER EMAIL: p4ywo yy� j,e6 5 Lea,-1lU t, Wet CONTRACTOR NAME: M j 12ee1 tom-- Ofnw5scisloc --, CONTRACTOR ADDRESS: STREET prig ,Halog Ati.t. 51-,A- cfY 514DhOvva ( , 1 STATE W II- ZIP et T CONTRACTOR PHONE: 70 6' 943-• 22,/? CONTRACTOR EMAIL: p z-yt t yI4 e- z j2 -$e it){�t• . vv l CONTRACTOR LICENSE#(REQUIRED): PA '1"I/2....occ S45 04, , CITY OF EVERETT BUSINESS LICENSE#(REQUIR-En9ZDS, , PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME:D ,n CONTACT PHONE: Z,c,/B , ci(44 „-12,9,g r`�t�4 CONTACT EMAIL: Da, 6 ' v (.-5 ,- „ Existing Use of Building: M Contract Price of Work $ [0 i 0-6-1D Proposed Use of Building: M Heat Source: ❑Gas EIFIectric FA Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: TA ommercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair IT.I. ❑Sign ❑Sprinkler • 'emolition ❑Change of Use DESCRIPTION OF WORK: pro vi& w-e_w- wk u>jv, cLCf lfvSG 10,14 vte- i v-irro w 'tt2 PA,iit a iP7 i S3/44/3 ASSOCIATED BUILDING PERMIT#(if applicable): ';`''Y' MECHANICAL PERMIT APPUCATION ',, ;",_ 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 I 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 9f )11 I Ce,fJ/V - (Chemical or Water INo.of Heads A i�j1 1 tG1 , CatoACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is tru= - d correct.W done pursuant to this per/iit must comply with current federal,state,and local law.The•rantin•of a permit onl authorizes a•• • =' •• ••• • •= lotions therefrom.Deviations must first be authorized in writing from the rng Official b=i••_ •_'•• =. - =ny c rcumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Vo 'fey 2�?VA- MI g" PE N dr` Owner/AuthorizedAgeennt Signature Date (Revised 9/23/2016) t �Q 4