1014 LOMBARD AVE 2021-12-17 - Laserfiche WebLink

NMI PERMIT APPLICATIO• BUILDINAECHANICAL I PLUMBING / SIGN I 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: 1 0 ly L,t'ni PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: in &j•j' j3 t.0 rgir TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: I gREET b p CITY STATE �("' ZIP 1 c� �J OWNER PHONE: 9 ZS .5 f% ©2 7 OWNER EMAIL: CONTRACTOR NAME: P&Ci `P� C /Y V r 11— w -e C ‘1 `-1(-4' I.- ' s CONTRACTOR ADDRESS: (3 4T( E(p 7 ,3 VI— E._ c_ • CITY STATE l,t. S ZIP 7 8 )L7 CONTRACTOR PHONE: Z S 2 2.4 S CONTRACTOR EMAIL: JG,t.; .ram Ccr c-r e u ZZr�„ �c t) Cc'r`l CONTRACTOR LICENSE#(REQUIRED): ��ke l�i�C 4SLa>J'1 opt 1' y CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): bQ 7e?3 PRIMARY CONTACT: 0 OWNER glYCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: y Z) --Z (} ` 0 .5 (, V CO rre c CONTACT EMAIL: r-e-lJ i n Co .r. r - ' c i CG r: t C m BUILDING INFORMATION Existing Use of Building: `j 'si c"`1 - Contract Price of Work:$ /6 Proposed Use of Building: Heat Source: OGas 0 Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse 0 Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 0 \.6 0 sAk• 1-q FG LKC.lcSa(ga 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 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#-1-2 q l J O1) Ow er/Authorized Agent Signature Date (Revised 4/15/2019) j/�