1600 121ST ST SE 2019-08-14 - Laserfiche WebLink

071-477- PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: ILYC.0 121 - (Si St Vv I C2,-4- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: t1/4-A"(C,k NQl=1 0 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET �!Loc '2- S1- 'i VV� c k S l d CITY G aki Q.k A STATE r.` ZIP 9 g�a OWNER PHONE: � • • p.7 OWNER ELM AIL: CONTRACTOR NAME: PA, \ ik t 2t t�w� WYE t z l„L.-6(1Y1S CONTRACTOR ADDRESS: �ISTREET { D 1311., i41g CITY !V\ k-V-(/V.V ak..k STATE I' V A. ZIP ci g?j CONTRACTOR PHONE: apt) •IQSg• IS7 CONTRACTOR EMAIL: ( -k' O nke,Gcb- ,C'_C�) CONTRACTOR LICENSE#(REQUIRED): r -QcG--1 (�`&1j�2A• CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C-w s "J PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3t.00. L,C , •95Od eitA-& ,a vo(,L,{l CONTACT EMAIL: .inft) ,t f eLNI,0 '1 BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ I ;)C'e Proposed Use of Building: Heat Source: SIGas ❑Electric ❑Other Building Type: ❑SFR-Detached ( .SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition DRemodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: "elAkrke,e. flAA9--NACLUd kli-e- a_14 4k_0( . ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures _Fixtures A/C-Air Handling Units Heat Pump Toilet _ Backflow Preventer(Inside Bldg) I Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain _Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water ' 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 B '.' g 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, :rid 1 omply •the -to,bntractors Law 18.27 RCW and 296.200A WAC. ilier 1 City of Everett Official Use Only Ay--\_ __, I ( .1 4 � PEMat�t1- 05-7 Owne` Aut •rized A•'nt Signature Dat (Revised 9/23/2016)