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1731 VIRGINIA AVE 2019-07-09
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1731 VIRGINIA AVE 2019-07-09
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7/9/2019 8:46:01 AM
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7/9/2019 8:46:01 AM
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Address Document
Street Name
VIRGINIA AVE
Street Number
1731
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'IPPERMIT APPLICATI <br /> BUILdEI I /MECHANICAL/ PLUMBING /SI PRINKLER/ 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink OnlyPlease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 173 I V l(j 1 n;Of AVe. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: VYt. ,i X. (''t I`Q A4 6 IBJ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 173 I iCyIrl 14 A,y' . <br /> • cnY Evefort STATE W4/" ZIP n 20 / <br /> OWNER PHONE: q23 ,.(0 © 212 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (� <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) 1.h4Arr" e OWhr✓ eety. R. Wf)400( <br /> CONTACTANAME:DQ CONTACT PHONE: t,l 2� 24 6 ct 33 <br /> �1/7t/fOt� I� • filed/ma <br /> i CONTACT EMAIL: IRAridv a M C d ftn o l(4_,61,4,4-;,+ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ —70 bp <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ,Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: rk, 1 /� <br /> (et11uc- 3 IA)'P3 of root,^S + rera0 — poss�ie1I Sot -hhe tv *1, p td0o IT POP 9J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING 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 t 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 /> ( ( 1 Li)a--1.-e Cle '545—I T PER # so Cr, oi3 <br /> Owner/Autho 0 d Agent Signature Date (Revised 9/23/2016) <br />
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