1011 93RD ST SW 2020-06-19 - Laserfiche WebLink

4677- PERMIT APPLICATIOC 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 I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION 54 PROJECT SITE ADDRESS: 1a3 rd �!-4venf+ PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot k "3Vch copy of long legal description) CONTACT INFORMATION V OWNER NAME: L-e1/\ V Q}/)n,X1 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREI 1 rd ' 4 G W r�.y JQ.`A- CITY 02 ' :✓J/ STATE�J ZIP vl B dot{ OWNER PHONE: XC71Q 6- 10,-,0 t''�4.--k OWNER-EMAIL jL/ Jd--1 4-3a ', CONTRACTOR NAME: — - 4 - QO r CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHON'L�Gj>3a) —15S-41CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: oLC-,i2.3 ).ALS(,t-JCi'ZiA , CONTACT PHONE: 20(o 5-c)/ ' 0.gZ0 CONTACT EMAIL: Kt,I)ij02,4-.S g) 1.-4va. DC7 BUILDING PERMIT APPLICATION Existing Use of Building: �\ ) (La �r4 Lry Contract Price of Work:$ --i j��-DlO Proposed Use off B •ding: 'S -`N&v V-64%�.t..c—�( Heat Source: ❑Gas ❑Electr(ic ❑Other Building Type: SFR-Detach ❑SFR- ached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial Type of Project: ❑New It7Addition Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use -DESCRIPTION OF WORK: [b Pa4- pie, d4 4- /`Y* )/ /� ASSOCIATED BUILDING PERMIT#(if applicable): A: MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair a of Project: _New _Addn _Alteration ____Repai ,• of #of V #of #of List of Fixtures List of Fi es Li of Fixtures List of-Fixtures Fixt -s Fixtures Fixtures / Fixtures —Air Handling Units Heat Pomp �f Toilet Backflo�nr reventer(Inside Bldg) Ufi Fo :. •it Systems it Heater athtub Ug+ I Gas Pipi , ,, Boiler Lavatory(Wash Basin ,"'brinking Fountain Water Heate 7--y," Refrigeration Shower -- Floor Drain Gas Fireplace % ,- Wood Stove Kitchen Sink&Disposal ,, Grease Trap Gas Range 77,�',,,,, Ducting Dishwasher Roof Dratns- Clothes Dry ups �,, Other: Clothes Washer Medical Gas �` -ange,,l-� o Water Heater,.-'r Other: Extds an Sink(Se . e/Bar/Mop/etc.) Other: j✓ e . - fel / SP INISLER/SUPPRESSION SYSTE /.< 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 /-St( 2-s44-d97.T— PERMIT / / 7cS 1 Owner/ uthorized Agent Signature Date (Revised 9/1;2016)