1518 MADISON ST 2019-07-24 - Laserfiche WebLink

PERMIT IT APPLQCAT9ON 11141 BUR.DUNG I MECHAMCALL I PLUMV3)NG I S)GN I SPRft KLER I DEMOLEIMON E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) • PROJECT SITE INFORMATION PROJECT SITE ADDRESS: : it i li'L(SOV) '+- PROPERTY TAX#: cC-)t-� U 70v C LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION • OWNER NAME: , 1'1DMISk la.0 TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 672---^, \� �lV� vN w CITY '1��[ * I `� " ^l r STATE A (�ZIP '"I a U Z O OWNER PHONE: -/. ' _^i (fit Qr� OWNER EMAIL: " ;." CONTRACTOR NAME: VW✓l ,r CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0-OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: 3-beCONTACT PHONE: 1.A.7:), I ZU 1.i1'''4tl CONTACT EMAIL: (✓vJvvx n�✓�," �., (C3r 1. BUILDING INFORMATION Existing Use of Building: Contract Price of Work: $ d0`» Proposed Use of Building: Heat Source: ❑Gas DElectric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ElMulti-Family-#Units: ECommercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ESign ESprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: \ co A,, rT3E--. 0Q,v hW-tv,c, 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 Ventilatior 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 i 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. 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 Everett Official Use Only PERMST ` cy O� Owner/Authorized Agent Signature Date (Revised 4/15/2019)