5527 BROADWAY 2019-05-31 - Laserfiche WebLink

1 PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION 141VCITY OF EVERETT PERMIT SERVICES ' .7 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue,or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADORES: 5 G-77 Oro PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 1.)/^c1/ P'(tZ i-a/d TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3 g/// f-�/,2 l Jr /_IF-• CITY 4,C/, // STATE (...../1G ZIP / OWNER PHONE: ®C - a g� 7 OWNER EMAIL: t CONTRACTOR NAME: AI/ 4.4„r— �Sj4-7lrG re CONTRACTOR ADDRESS: STREET ,? 3 Z 3 /62,'A, S S CITY /i/I/k- - '7C/(/l 5 STATE ✓- ZIP f l2 59 CONTRACTOR PHONE: j(2_tri,7_5-07CONTRACTOR EMAIL: 4,4 C L L G D e ,4 ( G®`^-^ CONTRACTOR LICENSE#(REQUIRED):/) G ,C- I3A C es 7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):03—y 2/6( PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L/2 5 7 7,2-- 06'q' / CONTACT EMAIL: T� -ca &.... . ‘,-...,.4 T/, 4.O'^^ BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ IN)I DOD. ©% Proposed Use of Building: G2 Heat Source: ❑Gas ,Electric ❑Other Building Type: TSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: Z.New _ Addn _Alteration _Repair Type of Project: X_New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC—Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) / Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Z Shower Floor Drain Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap Gas Range Ducting I Dishwasher Roof Drains / Clothes Dryer Hookups Other: ) Clothes Washer Medical Gas Range Hood Other: Exhaust Fan 16 Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I 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.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 Contr.ctors Law 18.27 RCW and 296.200A WAC. LAPPP— -- '—()— i 7 City of Everett Official Use Only PERMIT Ow-PAuth.nzedAg: tom! •'re Date (Revised 9/23/2016)