12502 16TH AVE SE 2020-08-28 - Laserfiche WebLink

= II II '' PERMIT APPLICATIO 1111 BM BUILDING'TMECHANICAL I PLUMBING/SIGN I aPRINKLER I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black IIlk,iQtIItjy PCea*e , >r... ' , . RO EG T'SITt INF9RMAT10 .... n� , `', ...$ �w. A „ .w .. . . .AF PROJECT SITE ADDRESS: V2, 0')___ \b ' Ave,aGI. PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) zez ,., ' , CONTACT lNFORMAT1ON .. , OWNER NAME: lC L''Lart TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 1,29\O _ 1,6 Av..( L - CITY A AA C7 STATE W\A ZIP Ct.IS l OWNER PHONE: 1_14,- qt - Zt 7.-`-+ OWNER EMAIL: CONTRACTOR NAME: •Fdd5 f , ge/'VrC,( CONTRACTOR ADDRESS: STREET` '-1, 61-v-\ -.1-p- - A.t� 6 /�p�� CITY 1-_ - STATEWJlJJ ZIP rtp03' CONTRACTOR PHONE: 253 $ Z' IA VI Li CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): '-'1,�it.,Q'2 1-61:---_A_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): "1 7- Z ..._� ��„rte. . � PRIMARY CONTACT: ❑OWNER 0 CONTRACTOROTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 1,k1,9 .- I - itN9 tM L`V\ Les5L CONTACT EMAIL: J t S Existing Use of Building: SSR Contract Price of Work:$ '/OC)0' Proposed Use of Building: SM. Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Com mercial ❑Accessory Structure Type of Project: ONew ❑Addition ❑Remodel ' El Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use. DESCRIPTION OF WORK: itt- - SFR • ASSOCIATED BUILDING PERMIT#(if applicable): - .. A:ECHANJCAL PERMit. 1;PP .I CATIOt+(.._ < ....... ' ;RLUM113040 PER.NtIT. PLICAT(QN'` 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 ::niPtIOS#4404:$700#1***10000-Witiegjil 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.tam the owner,or lam 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 PERMITm01 O '7121-1/l 6 (� Owne uthorized Agent Signature Date (Revised 4/15/2019)