2204 12TH ST 2020-08-28 - Laserfiche WebLink

PERMIT APPLICATIC BUILDING/MEC ANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION v .,I'',4I CITY OF EVERETT PERMIT SERVICES vig 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: ,2 L l a....,16, 5-7-- PROPERTY TAX#: q©5f 7OOa!zt-frx) LEGAL for new construction: Short Plat/subdivisioni Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: EVEr rr Pl AZA.Asi rE>Li 0 4& TENANT NAME(If Commercial):Evtier-Tr-n/,4.z4-A-sr,boil OWNER MAILING ADDRESS: STREET al37 17 Ave. SE #44, cn- rnegc re_ .l LArI Y STATE •V C/A- ZIP ggato OWNER PHONE L/Z✓// `t I v��{(p C/ gL¢ OWNER EMAIL CONTRACTOR NAME:NA/d-lJ/i Puifro Av6-1-1-116977A)6-- CONTRACTOR i /6 nJ6-- CONTRACTOR ADDRESS: STREET /6 4/11 /3, , Aup, fit/ , /CITY L0‘401,0AM-no)) STATE� ZIPq KO3 7 CONTRACTOR PHONE: L'2 775;41441 CONTRACTOR EMAIL: Se.. DX Avul7IVI - . NC r- CONTRACTOR LICENSE#(REQUIRED) D g.'�PHg114,4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) OI R 7 t PRIMARY CONTACT: KOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: //��,,/L�� CONTACT PHONE: L4 2�-2Z— 3 q,ice 0 K. CONTACT EMAIL: Cj611 dt4 u yt�� c 1a TI rvi-- BUILDING PERMIT APPLICATION ter' Existing Use of Building: Contract Price of Work:$ /1. 5 : 0 6 Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: gCommercial ❑Industrial Type of Project: kNew. ❑Addition ❑Remodel ❑Repair ❑T.I.• OSign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Zn/57-13-14-- A- A.e& 61AJ(rLe Ze)Nle-- DItCi- rS YEA-7- P 10 p , ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures NC-Air Handling Units f 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 ' 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 EverettOfficialUse Only �! L�� -r^ V/i1/,' PERMI 10 0 1 - t,/ t Owner/Authorized Agent Signature Date (Revised 9 23/2016) 6--)