11724 23RD DR SE 2021-09-02 - Laserfiche WebLink

� PERMIT APPLICATIO ni BUILDING�RfIIECHANICAL / PLUMBING /SIGN RINKLER/ 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 PROPERTY TAX#: '260 g2.�I0D PROJECT SITE ADDRESS: I I-J 2J� 23YL/.0 �� `T'S/i LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 'L(AAM 1C 4,L tAtil sgON(p 4L;i aNT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 111Zo- 23go pa cA., CITY - AJk b t/L J V STATE "" ZIP 762,08 OWNER PHONE: S47 2 q 22 w OWNER EMAIL: yti(lLi VYI9 0 V yt./G(l I- &urvvl CONTRACTOR NAME: OW '0' �2--- CONTRACTOR ADDRESS: STREET \ CITY STATE ZIP \ I-....�.....r�n c CONTRACTOR PHONE: MAIL: CONTRACTOR LICENSE#(REQUIRE it OF EVERETT BUSINESS LICENSE#(REQUIR D li PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR �� ( ,OTHER(Please Specify) p�'C/) �l wl�� rJ�i�� CONTACT NAME: � I CONTACT PHONE: Q 0 1 ' ?lt/nI��i� CONTACT EMAIL: ' n-N t)U @tpV1t,A4 L .CoN/] BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ 4-CjDO•cU Proposed Use of Building: GAF Heat Source: g7Gas ❑Electric ❑Other BUILDING USE: 'ISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition^❑Change of Use DESCRIPTION OF WORK: COW Uri- GAP. ,Oe&roovIA • S' ' ASSOCIATED BUILDING PERMIT#(if applicable): 71 MECHANICAL PERMIT APPLICATION ,' PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture List of Fixtures List of Fi ures List of Fixtures List of Fixtures Count Count Count Count NC-Air Handling Units Gas P,'.ing Backflow Preventer(Inside Bldg) I Shower,Tub,or Combo Boiler ,.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 I Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 1 Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Typ- Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(-•sidential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air S. tems Other: Medical Gas Water Valves or Fixtures Gas Fire,ace/Insert/Log Roof Drains Water Heater SPRI LER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppr- sion 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 circumst ce.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 RC nd 296.200A WAC. City of Everett Official Use Only I O_\ iltill PERMIS.O .r-/ Owner/Authorized Agent•V' n ture I Date (Revised 4/15/2019) ` `� I