12830 19TH AVE SE 2022-01-21 - Laserfiche WebLink

PERMIT APPLICATION' BUILDINLMECHANICAL / PLUMBING / SIGNWPRINKLER / 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 tee PROJECT SITE ADDRESS: \2_Z3D _ PROPERTY TAX#:dgej. '3000Y04)0 j)(� LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: i-D4shi)i 4 / ! S TENANT BUSINESS NAME(Commercial): ftL OWNER MAILING ADDRESS: STREET Lac Ple.le Slret71-- CITYL.JG�_7Wt? STATE /,/-/A-- ZIP 9210 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ),1, ..er S'/ 4 JAC• CONTRACTOR ADDRESS: STREET a'A/ W,' ?g ih CITY Il�"�Qn / STATE 7,Ug ZIP it o2 77 CONTRACTOR PHONE: 3 v.- 9dV—/J4)5 CONTRACTOR EMAIL: , ca),VS' CONTRACTOR LICENSE#(REQUIRED): i?'ILJerSC F '3 g CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �j 73/0 PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360~7��~! CONTACT EMAIL: Yn -/s6 /y, L D1 Sfi r:# i)ie L%��n��yiy-7- tom/ � Ge lei✓, BUILDING INFORMATION Existing Use of Building: of ii,u Contract Price of Work: $ � UG1`3 Proposed Use of Building: J Heat Source: ❑Gas DElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi Family-#Units: L'L' nmercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. VS(Ign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK:.02keiri9,42.15j7 i4 ✓n • /wN S/jo , //fig t��Cjrzy 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/InserULog 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 J A:74." I ZQ PERM! T(#�_ ZD O vlJu Owner/Authorized Agent Signature Date (Revised 10/10/2018) /