12029 14TH DR SE 2022-04-29 - Laserfiche WebLink

INIM PERMIT APPLICATION LI BUILDING ► ECHANICAL I PLUMBING /SIGN RINKLER I 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: I Z.ij 2`I I 1 b(2' ct, PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) ''AA CONTACT INFORMATION OWNER NAME: ta1lt`��(t„� L E,C.e(&li St.) I 1%OA TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 1 ZOZ1 '4 1 tt &- ,�l i CITY STATE �. /ZIP 9 �� OWNER PHONE: 4 " 9 C -Ot�j (4 OWNER EMAIL: 1110t1�LA�-St)��t(iA-1 Z, Ut"r(1BI,t:A,‘co i i l.-n CONTRACTOR NAME: A De th...,..` t �t fb rLS Ill it./144-C,(( Ci(- (4kI1 — CONTRACTOR ADDRESS: STREET gitB3 l CrLy st,L,L Sp 0,t tAc a w\ CITY 1;--)-(A-0 STATE 14A- . ZIPS 'c - 6 CONTRACTOR PHONE: ii IS•-(p 7 ^it, 3 CONTRACTOR EMAIL it 1"0K41 f f246e// CONTRACTOR LICENSE#(REQUIRED): Akbe.r bE ( ! k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED). 0'9 l f PRIMARY CONTACT: ❑ OWNER Ixl CONTRACTOR ❑OTHER(Please Specify) to Q+ r 10$ 2�6 � 0 tiN CONTACT NAME: CONTACT PHONE: -I Z tj -6 Pi r,C, W _I 1 )1/t tetildt-eA `A `—W ,C_ CONTACT EMAIL: IZA..Ui/3/Zasi;:. (I( tL44`'r. (.L)'1 BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ 1 i &W Proposed Use of Building: Heat Source: OGas DElectric ❑Other BUILDING USE: IRSFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use DESCRIPTION OF WORK: ng 1 j,, , 1 L . I a bc&t__ 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 NC—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/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 Contra s Law 18.27 RCW and 296.200A WAC. I 1 (LO City of OEverett Official Use Only PERMIT n �QO 3 Owner/Authorized Agent Signatu Da (Revised 4/15/2019) i/ Z