1220 75TH ST SW 2019-09-18 - Laserfiche WebLink

PERMIT APPLICATION , 41A)/ 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 Pteasse) PROJECT`SITE`INFO ,„�a . . PROJECT SITE ADDRESS: I -7-5 h * 6 W PROPERTY TAX#: ,9230 I I OO 1 0 a,Ooo LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) =CONTACT INFORMATION OWNER NAME: L� Q.- f() ) Cl J C/�lL LIQ m TENANT NAME(If Comerci I): �(�p YY, �U it S4-r CtiC t Uva OWNER MAILING ADDRESS: STREET C 1 8 y► F3 4 T T, S t,-c e s,,� ,, _ Cj Yl( v{l CITY # STATE (y a &�ZIP V OWNER PHONE: 3140—,35 — I1g-/ OWNER EMAIL: 1-'1 m cMXVQvY'\,0-C-+ CONTRACTOR NAME: S �S \Ay--'t f to CONTRACTOR ADDRESS: STREET 76/g i/g r ' 1 OX\ ft ��,\I(\(` y,\�`A‘IYI CITY (A) STATE Ci•P-D, ' ZIP CONTRACTOR PI E: 0.62-1 1."77/jp S CONTRACTOR EMAIL: f)e rr`n 1 5 &,<k.),n 4, Zi—.4444-..C.04 L.L Q,.CD 4 CONTRACTOR LICENSE#(r a 1JS P Z.q sa1_w CITY OF EVERETT BUSINESS LICENSE#( .• ' D): , PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) CONT CT NAME: CONTACT PHONE: Set:; "'":471-1 '� f Q C. Si 42.,1/4,(N.( 3 CONTACT EMAIL:per \ C �1 L Ulx3 A11+V F� BUILDING:PERMIT APPC *iJO$, Existing Use of Building: e_,O Contract Price of Wor .$ (pli );;D.,C•' Proposed Use of Building: 0.--C3".."`<'1 if C__ a_\ Heat Source: ❑Gas > ■Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 'ommercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. �ign ❑Sprinkler ❑Demolition ❑Change ofUse r DESCRIPTION OF WORK: it\ (� se) "*dt; C;c c c'fZ'� L L LEO l>,AYrniV\ 9 cL\, .-.- X\ k-o b lA,.\at,to ASSOCIATED BUILDING PERMIT#(if applicable): v MECHANICAL PERMIT APPLICATION PLUMBIINGPERMIT APPLIcATION,: Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures NC-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 f 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 Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only R Q� i /30/a0 PER Cg\2 — Owner/ uthorize gen S' nature Date (Revised 9/23/2016)