114 BARBARA LN 2019-06-18 - Laserfiche WebLink

PERMIT APPLICATION BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION �� CITY OF EVERETT PERMIT SERVICES J 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=Olnly Please) PROJECT SITR...INFORMATIO1 PROJECT SITE ADDRESS: t 1 - 1 f PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: MAI('D v V[i f l e— TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 11(36\CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: OUjU`2J CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: WNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT-APPLICATION .'_ Existing Use of Building: ?�iv'iry,( R5o _ Contract Price of Work:$ 1111.7( Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other Building Type: ❑SFR-Detached Ig FR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial Type of Project: ❑New ❑Addition odel ['Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: eim cui Vvt dL 1\cW.vi L cei-l-ico— I-C(i o (,(1 U�/ it, ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn Alteration R it Type of Project: _New Addn Alteration _Repair #of List of Fixtures #of 1st of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) j Drinking Fountain ICC Water Heater Refrigeration /Shower Floor Drain Gas Fireplace Wood Stove V Kitchen Sink&Disposal Grease Trap Gas Range Ducting ,/ Dishwasher Roof Drains Clothes P er Hookups Other: Clothes Washer Medical Gas Ran. ood Water Heater Other: E aust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER,%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.1 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 -1--)r-t--t)14 a (lite--- t%09 ' Owner/Authorized Agent Signature Date I (Revised 9/23/2016)