909 N BROADWAY 2019-01-24 - Laserfiche WebLink

I PERMIT APPLICATIOII SP' BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION ../ _ CITY OF EVERETT PERMIT SERVICES 104111 � M 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 (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 909 4 , 3 sp .,-D w A\m PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: v 2_5:71-- Low.,1 „ Cp =.E TENANT NAME(If Commercial): ��ik Mrs k OWNER MAILING ADDRESS: STREET ?o 'rDWT EZ ,s-c-, ./ CITY EV(+A,--7. ' STATE. ,. ZIP ?Oa) OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: (-V� 2©V.Int-- C-C- 4 , CONTRACTOR ADDRESS: STREET Ct �)? ( 1s'Fj�_ c i S Li N �T, CITY y ' 61 KLA0 STATE LA) ZIP 97©34 CONTRACTOR PHONE: .7.,(7...s.-) ( )59 I - `(�d�`aj CONTRACTOR EMAIL:J co le\ .1-i--)CrZA So a, t o•K CONTRACTOR LICENSE#(REQUIRED): F.,C3 - 0 SS Qj CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S 12`ZCD PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)) CONTACT NAME: CONTACT PHONE:(t.i�rc '> ( �j 3 ( - cra illiYL S© ) -eiCti S d CONTACT EMAIL: 40 N @ ti---, CO Sc in r. CeE" BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$.____51 C) D 0 Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: El New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: �} 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 #°f List of Fixtures #of List of Fixtures #°f List of Fixtures Fixtures Fixtures Fixtures Fixtures NC—Air Handling Units Heat Pump 5 Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub l Urinal Gas Piping Boiler 4 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 • ACKN.WLEDGEMENT:I have revie -.this apr ation and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with curr-nt deral,state,and I. . -w. he•anti t • a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the B Iding official before be. g aut'o ized u der' ircumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, a d I co ply with the St-to Cont ,.tors L:w 1: ,-CW and 296.200A WAC. City of Everett Official Use Only PERMIT# . .. _ __ „..../ggigallell3 ).-& e ( ( a - 00 I Owne Authori.-d Agent Signature D.'e (Revised 9/ /2016)