2015 LOMBARD AVE 2019-11-06 - Laserfiche WebLink

= ''''II PERMIT APPLICATION,' BUILDING 1 M CHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (B[aor'Blaclik intitiiilyt+tease)..:: ..... .,,,, 1*-0400 SITE;1NFO MATIf3C.. . PROJECT SITE ADDRESS: 20 5 L-0 A4112.V.0 Avi PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) . CONTACT"1MPORMATION OWNER NAME: KOLE meegee._ TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET ZQ IS- C.cM 13AR0 AI/(: CITY evetert-- STATE IAAZIP ' Qp/ OWNER PHONE: •591:7117_7!). 7 Q OWNER EMAIL: CONTRACTOR NAME: u)l.L.(t fl` QOQ F t nt A I G..,.<�RS' (N)C CONTRACTOR ADDRESS: STREETi��cJ�s,5 ('� Pa 6(AviAti ' S.T. A CITY //// i NHMwoa0 STATE WA ZIP 'ail lZ CONTRACTOR PHONE: Z%-307,."7(0`63 CONTRACTOR EMAIL: p rej g'J'h;I 1 io! Qv-P:0-.6 e-4- 1 CONTRACTOR LICENSE#(REQUIRED): CCNL ILL.S, (er t....C....- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): , 0 0 V , PRIMARY CONTACT: 0 OWNER ®'CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206 _-?-11 _ -7U' 1)A14 3Ot -tA CONTACT EMAIL: 4,. ..y ,:(fit;rpt ndocr✓ /.?Lei' BUILDING IN, RliAt10I Existing Use of Building: 7.e.51/94104...‘ Contract Price of Work:$ l3 bSI — Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ElSFR ❑Townhouse El Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel El Repair CIT.!. OSign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: go6F C2,i1P4A,c_eAAewJV f' ASSOCIATED BUILDING PERMIT#(if applicable): a}.,> Mi it00,INICAL PERMIT !1?'PLICAT1Ol+r ,. PLU MSiNG 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.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PES�O�"' O`4 Owner/Au orized Agent Signature Date (Revised 4/15/2019)