6509 BROADWAY A 2021-12-20 - Laserfiche WebLink

® PERMIT APPLICATIOI BUILDING i MECHANICAL I PLUMBING / SIGN / SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 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: lam` 'C'( f r,,C jc�,, 'U VI } A PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision 1 Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: rA C, -) C CC AA\CIA--Vai LLL _CONTRACTOR ADDRESS: STREET 2-2 c " i ( c\-c;--CITY C.� !`�t AV STATE LAD f t ZIP Cit:t tC.- CONTRACTOR PHONE: Lie --(-'.�„ 0,' Lc,(,-, CONTRACTOR EMAIL: C_D FXLCli'V\ ALAO(c t tINOL•C_�=flCONTRACTOR LICENSE#(REQUIRED): (jC N, s L� '1,?j.�1 CITY OF EVERETT BUSINESS LICENSE#(REQU ): PRIMARY CONTACT:tOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT ME• CONTACT PHONE: 3 ._p '6 „ V V . , l /L.� CONTACT EMAIL: or co"( CZ'C- Io'.,) (� 4 Ak'li, „/r• l II BUILDING INFORMATION Existing Use of Building: �'1^,:1t,i'�t �tt'(t l Contract Price of Work:$ _2)cI CC• (- PD Proposed Use of Building: /VLK(T/ I (it &f Heat Source: ❑Gas DElectric CI Other BUILDING USE: ❑SFR ❑Townhouse ODupItx DADU multi-Family-#Units: ❑Commercial DAccessory Structure Type of Project: El New DAddition DRemodel 4.1Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ` i,1 ` q b o,,r \-v it y, �� Lr_ l'ki Lc-1 ci v(1-- r,1 ic,L.r Zx -/ L,J f J , r a-e—d ASSOCIATED BUILDING PERMIT#(if applicable): 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 I No.of Heads Chemical Suppression System 1 1No.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 Cont ctors Law 18.27 RCW and 296.200A WAC. �� —I City of � off Everett Official Use Only D ,..3s\ r i1 -I PERM a 11#L ��/ L^ 0 / I �� Owner/Authorized Agent Si natu Date (Revised 4//15/2019) .)