12800 19TH AVE SE 2021-02-23 - Laserfiche WebLink

= • PERMIT APPLICATIO• BUILDING / MECHANICAL / PLUMBING /SIGN /SPRINKLER/ DEMOLITION EVERETT CITY 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 Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: I C-Sa.) £ O liked x:tr/- .i-I'i'" f xrcti-- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: P ro,,t'deP,c Med.,<-1- Le n-t r TENANT, BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: sTREa �,. C. SjNW I CITY STATE ZIP OWNER PHONE: LI Z 5 CI ZZ - 7-c OWNER EMAIL: CONTRACTOR NAME: f t 15 A)Cc CONTRACTOR ADDRESS: 3 `/sT / 1 Po r r CITY C i It rid STATE Ls-,A- _ ZIP 'Z Z(d CONTRACTOR PHONE: 3 6 0 -305-8889 CONTRACTOR EMAIL: 11- Incr 5 r.J p d`f r•5 Co-, CONTRACTOR LICENSE#(REQUIRED): t'1 fA t 2, (4-* T Z9 i G CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): `7 y PRIMARY CONTACT: 0 OWNER VI CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3, 0 3 v 5— ( 1 i�es (_.I2 f s lncuJ CONTACT EMAIL: -f- 1„ r 5�^��( ��f 5 co", i LOST BUILDING INFORMATION Existing Use of Building: Wye ''C- L 6_L I e Contract Price of Work:$ Z-C1 S , `'° Proposed Use of Building: ed'r-` Heat Source: ❑Gas ❑Electric IZIOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: DCommercial ❑Accessory Structure Type of Project: ONew OAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: D J Zo `rye LEA I ve f ASSOCIATED BUILDING PERMIT#(if applicable): y V I"—035 MECHANICAL PERMIT APPLICATION PLUMBING 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.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 com with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# ff 260 \ CISS- Owne uthorized Agent Signature Date (Revised 4/15/2019)