9107 EVERGREEN WAY 2022-06-28 - Laserfiche WebLink

PERMIT APPLICATION BUILDING IECHANICAL/ PLUMBING /SIGN /gPRINKLER/ 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: (Wig EtAciyu-c h klay eue0c41-t p14- 940 PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: _', ,g:f4t,_ ri TENANT BUSINESS NAME(Commercial):Ann aj 47 t '-� d r1 J t?/� OWNER MAILING ADDRESS: STREET la 6 :(p(0 CITY Etceyte'ft STATE ZIP g824 3 OWNER PHONE: q2s--77a -,Z 15 OWNER EMAIL: CONTRACTOR NAME: Ltice2Garty3 451 At F % A tk. CONTRACTOR ADDRESS: STREET ".(2a f iAi,.,c..L AL;( CITY E. 6,2-tr STATE tAsfP ZIP L40 Ge/ CONTRACTOR PHONE: ems-24 2 .-5i14 CONTRACTOR EMAIL: to @.ess-ifrikv9r Cav+-I CONTRACTOR LICENSE#(REQUIRED):�,�,��Q eie-ce>5502 2ti y CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): a,9 e s - PRIMARY CONTACT: ❑OWNER Q'C:ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: /,^i') Q� � CONTACT PHONE: 421 -2J )- 3i'Y CONTACT EMAIL: &I a r-k_c? e.jr i Wit c owl BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: OGas ❑Eleectric ❑Other ❑ ❑ �� BUILDING USE: ❑SFR Townhouse ❑Duplex ADU ❑Multi-Family-#Units: L+�'Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: p.9 ^R C (A-144- 01: -v fj F 1-,s34 263 0.44, RezAt 419/off ( £vIoA4ItOL ILK t0 Ls vtdi- 5t 1 ocdtyia,J, titfAc_c r 14Wy 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: kNtkk2l 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# O 3 311e121 MZ\ 051- Owner/Authorized gent Signature Date (Revised 10/10/2018)