2830 107TH PL SE 2019-08-20 - Laserfiche WebLink

PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES grr 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I 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: > . 30 1 Or 1'pt.J e PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: doh h( 4 1> tt�7 s p TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET p2U'D ,/D?~tom 3r /� CITY L-1 y,i STATE ILA- / ' ZIP 9 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: eV!For 0 QTz-hq Q6--y—O c"01/4"5R(Ael CONTRACTOR ADDRESS: STREET .. SO -Cu 13/4 1 CITYr � STATE �ZI�PgQa 6 CONTRACTOR PHONE: A0(p —�776'- (0 33 0 CONTRACTOR EMAIL: Mtge,, Y'I writ ��""B, by +- ,r, 65 CONTRACTOR LICENSE#(REQUIRED): ®a&tri® $ CITY OF EVERETT BUSINESS LICENSE J#(REQUIRED): L (-7k ` PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: y a CONTACT PHONE: j3 -�t x,.6330 1 K& 1r4IZ NPt CONTACT EMAIL: p®: g_ ►Ic 6[6 BUILDING PERMIT APPLICATION M Existing Use of Building:afl wej y' ' I(. Contract Price of Work:$_ /1 V j9 �1 V2 Proposed Use of Building: () Heat Source: ®"Gas ❑Electric El Other Building Type: C FR-Detache. ❑SFR-Alta hed 01>plex ❑Multi-Family-#of Units: ❑Commercial El Industrial Type of Project: ❑New ❑Addition ❑Remodel eepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK:�tildy��'*e )—4i , Wire/ (' ` 4 • .10, i n -n. �A n 6�Kt- 3e4 _.,.v••'" l "'�''-yWj• irfor II r•• 0y,�: tl1;41 ler)...No, I �. V dQ L�yf / U.•�,,`�•1. 1 '/X(��j• LoZ) ASSOCIAtIVAtA-I ILDING RMIT#(iapplicable): I, ,G ign R .- o iT ` r 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) 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 I 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 Contractor-Law 18.27 RCW and 296.200A WAC. City of Everett�ttOfficial Use Only r PE^.' t O0 O - 0-X er/Au-hor',ed •gent Signature Date (Revised 9/23/2096)