9120 CORBIN DR 2023-02-06 - Laserfiche WebLink

® PERMIT APPLICATIOP• Uzi BUILDINGGJiECHANICAL / PLUMBING / SIGN luTPRINKLER/ 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: -4 12•0 r_g RE1 N PR• PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A:,,,e,,at, /4 ,PX TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 54,,LE CITY STATE ZIP OWNER PHONE: 1-b(o • 349• 1277 OWNER EMAIL: CONTRACTOR NAME: LE/J I SON Pity. (sw- 9/• f s) CONTRACTOR ADDRESS:NO ff STREET 6?' /v /MA/1/( it yi& CITY STATE • WA ZIP 51g Z.� CONTRACT R PHONE: LIZS • 60/'0(2-3 CONTRACTOR EMAIL: 4 /tBei,LS/U.f A AIS ew g/j,(ad . CONTRACTOR LICENSE#(REQUIRED): 14-AM 13L 514-9ZZD. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):5 3(,64 PRIMARY CONTACT: ❑ OWNER ( CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L/Z S'Sly f- D/7,3 in//eCONTACT EMAIL: C7747 BUILDING INFORMATION Existing Use of Building: Q . Contract Price of Work: $ S06 Proposed Use of Building: G ,Q Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ['Accessory Structure Type of Project: ❑New GifAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION 1O4F WORK: i6f1, ...gm:Li 7[6 $4.147ariory.71 - 1:?) 4 t i I,,r e 4,t 4 e,"ift,i_ 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 1 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 gr nting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the Building Official before eing authorized nder 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 State Contractor Law 18.27 RCW and 296.200A WAC. f �/ City of Everett Official Use Only � /7 PERMIT#I f 61 D- a A 1 S Owner/Authorized Ag nt Signature !! D e (Revised 4/15/2019) fy�