6419 BEVERLY BLVD 2022-01-21 - Laserfiche WebLink

A PERMIT APPLICA*I BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.evereftwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: �� ?�C•' I (SI v� Cvcrz.j+ Lc° A , f g2 3 PROPERTY TAX #: ems: 3(l,, cx)0 c�oG. VU LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: rclri G1:1ijayti TENANT BUSINESS NAME (Commercial): OWNER MAILING ADDRESS: STREEJ2- T ( CITY x V VY'Y'7) C4, STATE 1 �j/X ZIP L OWNER PHONE: 7)0 7 3� -5` 7ScZ OWNER EMAIL: %e{-. CONTRACTOR NAME: �)(,A_ CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: 9'OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: %BY7 6UL✓Gr c¢ yYiC , CONTACT PHONE: 2/0 7 3 y CONTACT EMAIL: BUILDING INFORMATION Existing Use of Building: 5' i 4,y le Contract Price of Work: $ Proposed Use of Building: 5,A/w /_, Heat Source: ❑Gas E3 lectric ❑Other BUILDING USE: OSFR ❑Townhouse ❑Du lex ❑ADU ❑Multi -Family- # Units: ❑Commercial LIAccessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑Sprinkler Odemolition ❑Chan a of Use DESCRIPTION OF WORK:�0 /Lcr?�c✓>?.J%�Tz/vC1L �s�raa / 174- u2�� Crs .GLrc<r� �✓Ct!!S tus rukw 17 C`.L�l2D✓` �L�`L� Ycs� ! h �c[s��27c'.:x.f- �� /iG>� ��ruy rv,u.( fxs 7�eSt;'-z:clt1� ASSOCIATED BUILDING PERMIT # (if applicable): Puy 'N"c-C MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Count List of Fixtures Fixture count List of Fixtures Fixture Count List of Fixtures Fixture Count List of Fixtures A/C - Air Handling Units Gas Piping Backflow Preventer (Inside Bldg) OW Shower, Tub, or Combo Boiler Gas Range Clothes Washer Sink -Commercial (3-comp, prep, floor) Clothes Dryer Heat Pump&Ductless Dishwasher 4ifer- Sink -Residential (kitchen, bath, bar) Duct System (Remodel) Refrigeration Drinking Fountain Sink -Utility, laundry, mop Exhaust Fans (Residential) Commercial Ventilation (Not Heat/AC system) Floor Drain Toilet Exhaust Hood (Type 1) 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 / 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # ) �31I ,6 ' �1 I / , "- , / Owner/Authorized Agent Signature Date (Revised 1011012018)