2428 STATE ST 2019-04-17 - Laserfiche WebLink

I PERMIT APPLICATION /f4P/Alli,„/f--A' BUILDING 1 CHANICAL/ PLUMBING /SIGN /SPR�NKLER/ 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: 2 /2-c5 S , (9--c JJJ4 L 'w/ PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION /OWNEOWNER NAME: "tiV60)4/-\ 4/ 7 j TENANT NAME(If Commercial): ....------ OWNER R MAILING ADDRESS: STREET CM Z, 0.,�,IA"`.V/e.c l.!' ,(,,Q CITY O,,Al - STATE fi,14-- ZIP 02_0 OWNER PHONE: 2_04.0. 1}— 010 -1 OWNER EMAIL: VW w g V n<St-Lys, (.L_ CONTRACTOR NAME: ©(J5 h. ,e_. CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 014 , S 6.D1,63 EljeliV1 L_ J CONTACT EMAIL: /nStoCbn- BUILDING PERMIT APPLICATI \ Existing Use of Building: Cr-:-W....— Contract Price of Work: 4 L5D 0 Proposed Use of Building: ,S17)2- Heat Source: CI Gas ❑Electric ❑Other Building Type: &I/SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use DESCRIPTION OF WORK: be4NAO pe-11(1/1 . r h.0%,..) , ,evcse.,.o- __ - ASSOCIATED BU DING 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 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 ACKNOWLEDGEMENT:l 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PEcy..1)T# i • ,/, //215/1 ----- .--- 01 s5 Owner/Auth. ed Agent Signature Date (Revised 9/23/2016)