709 N BROADWAY 2019-03-21 - Laserfiche WebLink

PERMIT APPLICATION S BUILDING/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: 76q 6 rau, 8 w,,„, PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: C.()S Do T TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 7 Q q E c-oG 8 w a`k �f CITY EUe,-e—� r STATE w 11 1 ZIP O O I OWNER PHONE: y.2.S- " 25' -- o 7 443 OWNER EMAIL: Fa i Vt te,5 ()w s do I' e w U.. q Oil CONTRACTOR NAME: Gus Dor J CONTRACTOR ADDRESS: STREET / S 7 U 0 D oy i t " 0l V‘ N ti cITY .3( - (.' C STATE w B- , ZIP 7? /7? CONTRACTOR PHONE: 206 - C/O - 6:7.5— r CONTRACTOR EMAIL: CuG(IS/ 0 WS-do- . W c, .j a‘✓ CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER .(CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Q b - S- 10 - 6"35-• Z-6 N h LA.) fin 1 11 CONTACT EMAIL: W 0,I IS/ @ (..,./$dot , LL/CA ,/chi BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ )D U. o-, Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: re ?IGc-e 11or t,_,c,t-er To.vkk; CI ;kt Fo-r I % k ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER"/SUPPRESSION SYSTEM ; Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System 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.1 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only j G /---2. _ n - / PERM [O\ '"'" 515 " V ly Ownhodized Agent Signatur Date (Revised 10/10/2018)