1517 BROADWAY 2019-07-12 - Laserfiche WebLink

PERMIT APPLICATION BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION II I41‘1/1 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 P$od'`[7V44,-1- PROPERTY TAX#:OcD553C0 31 GOO 360 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: K 1 M 1-161.--31›0 g.C - 1--1 TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET P C .:!f>/4.. I 1 I I WVII2-- - \N ' 2OG CITY STATE w ZIP CLe'rrG.r>-�� 6 OWNER PHONE: OWNER EMAIL: /" OWN3 `' f s�-n CONTRACTOR NAME: V WN 1� \ ..— ..--- ,..9CONTRACTOR ADDRESS: STREET ` ` CITY _ _ STATE _.. CONTRACTOR PHONE: _ _, CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED):G _ _ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 142-5 5a . lD9 OW QC--'62- CONTACT EMAIL: E- R:;_goo- �( .,_�� - i BUILDING INFORMATION Existing Use of Building: S F R Contract Price of Work $ ibazi_____________ , Proposed Use of Building: p iZ- Heat Source: ❑Gas lectric ❑Other BUILDING USE:2SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accesso Structure Type of Project: LiNew ❑Addition ❑Remodel gRepair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 13V 1 L p -ax.-m.4-%ra r t°-k r, / dQ lF .0A c vis, ) le.j_c. g.%or wr, 1rjcllff�r�,vt�n^4'l6' 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 NC-Air Handling Units i 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) t Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatio Floor Drain tf Toilet Exhaust Hood(Type I) (Not Heat/AC system) x 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 I ,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.I 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 Evve'r'eett Official Use Onlyly • �l2.......... � PE T`+�� \ i r'oc 3 Owner/Authorized Agent Signature Date (Revised 110/10/2018) G