1517 BROADWAY 2019-07-12 - Laserfiche WebLink

PERMIT APPLICATION #11"/1111.1P-A BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION CITY OF EVERETT PERMIT SERVICES 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 Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 15 17 ' =Oies'>`NA+"' PROPERTY TAX#:00.555 Cc,Si GOO 550 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: •1M 1- i--a C, -• t ' TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET Pa I i'1 re--12.- -r vies. CITY - V-rst: t-�- STATE Wilt ZIP CR,e 12/4 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: P--6:3 °--f"� 14t5 1.-Ire, CONTRACTOR ADDRESS: STREET 'ZC)Z3 ►--(W 9 T T t CITY STATE IN ZIP 3 1 t� CONTRACTOR PHONE:2Ot ,G` f I71CONTRACTOR EMAIL: V/t U [C.L ( COAN CONTRACTOR LICENSE#(REQUIRED):REA V1/1-1 L a- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Z(767 ' C,Q 6 6 '.J 1 (.=l"" CONTACT EMAIL: EP.).... "1`Y I7(1L:ta-{,CO N\ BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi Family-#Units: ❑Commercial EAccessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System 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./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 PERMIT# Owner/Authorized Agent Signature Date (Revised 10/10/2018)