2705 12TH ST 2019-06-05 - Laserfiche WebLink

PERMIT APPLICATION BUILDINd J IIIECHANICAL/PLUMBING/SIGN / UINKLER/ DEMOLITION 41.14CITY OF EVERETT PERMIT SERVICES • 10141111W-1 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: L 7 O$ 12 J J 1 PROPERTY TAX#: 2 ciO S'1700103 2O1 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) .�1 - CONTACT INFORMATION OWNER NAME: �V=2 IA-0t1s i A1C;. j 1} , TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ' C.3(0`-] COI V3.., � CrrY v -eE r Q r�STATE A i/i- ZIP 9 5 G_O k OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: T CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: fdOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: cfZ J- 2o"3 s--43 ` oz, 1---ocr 6 .i L/ .40-r�7 L- CONTACT EMAIL: d—pr.Y,t-c l k Q_ e... i 1\if , CS- BUILDING PERMIT APPLICATION \J AveExisting Use of Building: "' (i-r—'4—rvi 4._e-I '}T Contract Price of Work:$ i&I 000. ;--- Proposed Use of Building: Sf-rvt€ �HeatSource: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex I�Multi-Family-#of Units: Li ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition CI Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable):x.2110 5-O F1 MECHANICALERMIT APPLICATION PLUMBING hRMIT APPLICATION Type of Project: —New_ Addn _Alteration _Repair Type of Pro/ec. _NGw 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 ti Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Y Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove y Kitchen Sink&Disposal Grease Trap Gas Range Ducting y Dishwasher Roof Drains Li Clothes Dryer Hookups Other: y Clothes Washer Medical Gas Range Hood 1 Water Heater Other: 846Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM 'Chemical or Water L 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 properly 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 ...--\E 6_ PV em- 3— 1 PERMIT# Ov Owner/Authorized Agent Signature Date (Revised 9/23/2016)