Laserfiche WebLink
PERMIT APPLICATIOIpi <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN PI/RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue.o Black lnk Only Please) . PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: CiCi t l9�'N AYE SE PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION 'v£ <br /> OWNER NAME: JokkN Irpay TENANT NAME(If Commercial): ' <br /> OWNER MAILING ADDRESS: STREET ISOdp 3TUDIr8fKE12. R.D. SU I'M 305 <br /> CITY CalutaTas STATE ('KI, ZIP 90703 <br /> OWNER PHONE: (3 2 3) 585 -p40(41 OWNER EMAIL: <br /> CONTRACTOR NAME: ERNIE tit�(A`IKI ( MAD15(11\t 1NIUSTRAES) <br /> CONTRACTOR ADDRESS: STREET 1$000 .5TUDESAKtR RD. SUITE. 305 <br /> CITY CE(UST OS STATE cot, ZIP 90/03 <br /> CONTRACTOR PHONE: (323) 2(D$—1 C1 13 CONTRACTOR EMAIL: ecr\at1 et o@ md a5on'ind.envn <br /> CONTRACTOR LICENSE#(REQUIRED): (000—157- yl to CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57441 <br /> PRIMARY CONTACT: ❑OWNER IS CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (323) Z0&- is 13 <br /> RNIE AWA'IA CONTACTEMAIL: eQYIQtIa rnetdlson\nd•('.nm <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 6145 STATION CA NOP' Contract Price of Work:$ 10 I (950.00 <br /> Proposed Use of Building: GAS STATION CANOPY Heat Source: ❑Gas RIElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ECommercial 0 Industrial <br /> Type of Project: ❑New ❑Addition RIRemodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: WE, 1NLL $E pLl•1trlgG TSE CWNopy Top pop, ilk 1,5 CtRS ST t-CloM: <br /> New Det4 114SNJ �ASc1A, New v-tT�RS I RIsD NEW Ovi&kGiGe.a.s . Li Ke Foi2. LIKE. <br /> 512.E r'►ND ST1211C.TU11-7✓, of THE CAN®?` . W 1L L REMAIN AME. <br /> -ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL;PERMIT„APPLICATION ';` <br /> PLUM„B,ING ,PERMIT APPLICATION . `' <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit.Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood _ Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Chemical or Water I No. of Heads <br /> 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 <br /> 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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ‘11126 <br /> 9-2G-17 <br /> PERMIT#611,61 <br /> v' l <br /> Owner/Authorized Agent Sig Lure Date (Revised 9/23/2016) <br />