2410 CLEVELAND AVE 2019-08-07 - Laserfiche WebLink

PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER!DEMOLITION 44":"*1117.;"-A— 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: Zt(10 C LC VLN J IAV L PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: f tINI0q;'f EA f Z OClr TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 2 ((� L.LVLAt.!k 1qO L CITY b v�It Err STATE ,AI A- ZIP OWNER PHONE: L/Z S - 25/6,- O9 7 7 OWNER EMAIL: CONTRACTOR f--12A I^ CONTRACTOR ADDRESS: STREET /We:23 (.57-e k/41C r-- )2_) () CITY �(J/,,/ ," NA7��GSTATE CAZIP /!� 7O CONTRACTOR PHONE: 4"2. ,$1 .-443 br�1d CONTRACTOR EMAIL:(..=0Rey. A L.I 9C AA"i e-14- 10 se.co/, CONTRACTOR LICENSE#(REQUIRED):3�1 FRA SL, g'j'Z I Ca CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OS-1 log PRIMARY CONTACT: 0 OWNER pCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: a CONTACT PHONE: y 2$' ,67 S ,�7� K � 1t "( L,L xAN bG cZ CONTACT EMAIL: Co QC y kLeKi t p 5C .cOM BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ /dame oO Proposed Use of Building: Heat Source: ,oas ❑Electric ❑Other BUILDING USE:/FR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use DESCRIPTION OF WORK: LoC_ArSar^.( OF Titer CtkS Mc�Tc-�1Z. 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 / 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.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 'th the State Contractors Law 18.27 RCW and 296.200A WAC. / City of Everett Official Use Only 9I//'/?' PERIV lat I wner/ uthorized gent Signature Date (Revised 10/10/2018)