2715 15TH ST 2019-06-05 - Laserfiche WebLink

PERMIT APPLICATIOI1 p"" BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION ‘4 4d 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 7 ) 5 ( S"ys'TS PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: l;V e)j 1-1 LS) rT`HrENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 3 10 1 C O 1 lA \ CITY C i Q STATE �`� ZIP 1 8 Z0 1 OWNER PHONE: YzS 2 - S-�t 3 OWNER EMAIL: r Nr-15 @ e J p rbc CONTRACTOR NAME: S CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 4 f Zr Zcj 3, TZ / 3 £ 'r b J 4eA+1� ) _ CONTACT EMAIL: r"ct OICita9 Q IftA- a p BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ S—OC!) — 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: 24-R. G ecs 1 as C 10 440+ 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 NC-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) ( t i Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) `'J 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.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 Z i � yI I PERMI��#1 D 01/1 ) y - I vl Owner/Authorized Agent Signature Date (Revised 10/10/2018)