5106 23RD AVE W 2019-06-12 - Laserfiche WebLink

. 4.7.7 PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 � ��AL /� (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.e t / PROJECT SITE INFORMATION PROJECT SITE ADDRESS:510/ ? r61 V 'e / r I PROPERTY TAX#:/1�' ( f j/�' LEGAL for new construction: Short Plat/subdivision�]V l'(f Lot No. (( (attach copy of long legal description)/ CONTACT INFORMATION OWNER NAME:ChQ ih el(101V TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 06 i (1) CITY I erti-- STATE ZIP 1/27 OWNER PHONE: Lis' / ,<7VVV 3 OWNER EMAIL: --y V "K��fff CONTRACTOR NAME: 3 I Je f'/J� CONTRACTOR ADDRESS: STREET 1 11 1 ZWIll ST,.9(� (04-- J'� CITY IAJ 7 1L(,1 VVa/ T STATE I ZIP%Oi ) CONTRACTOR PHONE: '`Z-7i I1r7 �YY"^�ll CONTRACTOR(• EMAIL: `IIVJJ""' ��`��'VVV �/ CONTRACTOR LICENSE#(REQUIRED):13L(J FFH CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O S7C7O PRIMARY CONTACT: ❑ OWNER -IN-CONTRACTOR ❑OTHER (Please Specify) CONTA T NAME: CONTACT PHONE: LJ�� ' – —]f 3'a �� CONTACT EMAIL: in� l/� �I !im -/I um BUILDING PERMIT APPLICATION /�'`� Existing Use of Building: Contract Price of Work:$ i f,(i0 Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: -tISFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project ❑NewAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use DESCRIPTION OF WORK: likc, and kind -Pcvna( Gram are ��yq/p iizivi ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New 1/2' Addn _Alteration Repair Type of Project: 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 `1 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 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/ SUPPRESSION SYSTEM Number of Heads j 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 1 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 / / II IS PETl ')Cl CCC Own- orized Age_nt Signature Date (Revised 10/12/2015)