5843 HIGHWAY PL 2019-01-18 - Laserfiche WebLink

PERMIT APPLICATInII /— BUILD / MECHANICAL/PLUMBING/SIC"SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits y PROJECT SITE ADDRESS: `j f U'4 (P 1 - I PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. 1 (attach copy of long legal description) is 11. OWNER NAME: ?GI .-ha. g-cCi P Y1�.tx,n`o 5 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET {-al `. MANNA %1/4-)e{eir 1.."\lAdi1/4/ I CITY 'c p l I, � `' STATE QWNER PHONE `'t C�' _ I ZIP Z _......._�. ,.....��_ w..,..e.. �,�,..��'.� ��--L� � OWNER EMAIL: CONTRACTOR NAME: \,1\)e —t- C 0 aQ,--\'-- 0 kA YO‘f "') CONTRACTOR ADDRESS: STREET 1 L °Ik 6(L--I m S'� . CITr \1 "(J� ��1y ^ ^� Sy _.l f�ST-(ATTEE �." f ZIP��V `' i, 6O TRACTOR PHONE: 3(,(1D- L*o15 i c tY\../l CONTRACTOR EMAIL: `\�-t��"kc,A-C S \ ;i(Y 0(1 IRC1 !l CO TRACTOR LICENSE#(REQUIRED): \ 'VCC.• -yam, 1 1 S 10 CITY OF EVERETT BUSINESS LICENSE#(RE4UIRED)�S3 T �!1 pill Y CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT TACT NAME: I /� % ( \`^ CONTACT PHONE: '?��} - (2)- - 1 O I ��' '` ` vq CONTACT EMAIL: Existing Use of Building: Contract Price of Work:$ % 50• Hroposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other , Biuilc ing Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial Typ4 of Project: (New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF ORK: \(..e ‘(,Aj,{ \\(1% \\0, -\- 0--y\ ASSOCIATED BUILDING PERMIT#(if applicable): Type of Project: New Addn Alteration _Repair Type of Project: _New ___Addn Alteration _Repair i #of List of Fixtures #of #of Fixta►res Fixtures List of Fixtures Fixtares List of Fixtures #of List of Fixtures i Fixtures NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside BIL„) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain , Water Heater Refrigeration Shower Floor Drain I Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas i Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: !�4.�an Tv: Chemical or Water t t 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 cure en 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 I Build/ •Official before being authorized under any circumstance.I am the owner,or tam authorized by the owner of this property to perform the work for which application is ma.e, anq I•.mply w'.the State Contractors Law 18.27 RCW end 296.200,4 WAC. alp _ City of Everett Official Use Only 4k PERMIT It( i 2-A k dog -6 Owner/Au orized Agen Signatu - ` ' Date (Revised 9/23/2016) t