1602 PALM AVE 2019-06-11 - Laserfiche WebLink

PERMIT APPLICATION BUILDING -CHANICAL/ PLUMBING /SIGN _MIINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVIC= #M� 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or.Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: ( O2 ?ck‘rn a . ��ej>"(JA °%vos PROPERTY TAX#:065-31 j Pj i o 1.51_6()._ LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ,1m � ��ra�S � ;�,L TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET k �W Q ve CITY STATE tA1AZIP c OWNER PHONE: L ,2t.; "�ajo._3 � OWNER EMAIL: kk.lt"boIy .,_s i yal/1m CONTRACTOR NAME: 1 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: mszt tAA A CONTACT PHONE: fr -3c® 3 j Cek CONTACT EMAIL: 91:56lyn—s 460.Cowl BUILDING PERMIT=APPLICATIO Existing Use of Building: Contract Price of W,'rk:$ 1 00 Proposed Use of Building: Heat Source: ❑Gas _ ■Other Building Type: ❑SFR-Detached ❑SFR-Attached 0 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: r G\n; tn ASSOCIATED BUILDING PERMIT#(if applicable MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New _ Addn _Alteration epair, e,re_ Type of Project: _New _Addn _Alteration _Repair #of #off #of Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 X 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 I 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 Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only CO 8�7� PERMIT II�J Owner/Authorized Agent Signature Date / (Revised 9/23/2016)