6930 LOMBARD AVE 2019-11-07 - Laserfiche WebLink

PERMIT APPLICATIC rdoll BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I 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: (d9 3 0 to j41/ AR.. PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: L E Rf-eK L-I4 TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET (.0q ?j D L-OM is/ RAi.e. A q 2v�q CITY Ev E I'E yr // STATE c.t�A- ZIP I 1 OWNER PHONE: (t:/25-) 29 9-SS 7(a OWNER EMAIL: / rre.%YVI GG e 5 1 /. G©W1 CONTRACTOR NAME Adot i-co i 1' s-1-fru-ATIOAI CONTRACTOR ADDRESS: STREET 2192.7 gica pi-Ott/it ij CITY ev>r q`t'r" STATE (VA' ZIP agL'[.A, CONTRACTOR PHONE: C3c,d) 5/- 79V-0 CONTRACTOR EMAIL: �jy� CONTRACTOR LICENSE#(REQUIRED): /3g/}7Q,t t' Co ) LT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Co 5 9 7 7 / PRIMARY CONTACT: 5 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: q 10Nv�141'rbbl{ eJ 3„1 Q;',COW% CONTACT PHONE: V CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ /O 3 7 Proposed Use of Building: Heat Source: I21Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial CI Accessory Structure Type of Project: El New DAddition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use c, DESCRIPTION OF WORK: `evyte"t vLet c5`4 u0Ot04 S� V, Ue C,..v.ok r uN r t'&c Lj S c t` a-e- 8 a5 p t`f)t�+'t J z A 6 c<-eepla1c€. ' e,A t 4 ,t1r'nc,/ new act) i►nserf-. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION FixtureFixture Fixture Fixture Count List of Fixtures • Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units I )(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 I )C Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Chemical or Water I INo.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 ‘------ PERMIT# �'° — 2.Z7 ry e®2 --0L' Owner/Authorized Agent Signature Da (Revised 10 10 018)