2509 COLUMBIA AVE 2021-11-02 - Laserfiche WebLink

grr PERMIT APPLICATIO BUILDINs ECHANICAL/PLUMBING/SIGN PRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov( www.everettwa.gov/permits (Bkw or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:Z$(t COW YVi&TA Q>f PROPERTY TAX#0,90-6StD,X6 30b LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Deo/j, fall I/5 A TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET Z€oci CITY 2 r 7 - STATE WA-- ZIP �826 OWNER PHONE: �25 2,�j.-Oq� r OWNER EMAIL:J 4 RCA l.A OwA1 T'R2iS3VI-TN&•4M CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR UCENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): PRIMARY CONTACT: JELOWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: t.j25 3 --OR'34 Doi, cAJ U' A CONTACT EMAILrioNecm oikeDcreownl0rSr2r or=u&,6pM BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ief I / 661 -001 ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Rxruro 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 Ventilation 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 l SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other Water Suppression System I No.of Heads Chemical Suppression System I No.of Heads ACKNOWLEDGEMENT:!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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, and!comply with the State Contractors Law 18.27 RCW nd 296.200A WAC. City of Everett Official Use Only I PERMIT# a / � �,� ,d' -6O3' 074 Owner/Authorized Agent Signature Date (Revised 10/10/2018)