10719 19TH AVE SE A 2023-04-07 - Laserfiche WebLink

= PERMIT APPLICATIO wil BUILDIN ECHANICAL I PLUMBING /SIGN G . RINKLER/ 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: /0 7 / 1 /1 t-h five. s 4 Jr k PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision 1.; \i i" i Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: kg/10 Z-r z lice\ TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 14 j 7. j %,', ?toy-ec j-i 0.- CONTRACTOR ADDRESS: STREET /y(' /?04/4 f-a:,1. (f C.-C Or/Nye . CITY C/e EA), STATE UM ZIP %p 9 ea CONTRACTOR PHONE: '-/2S 30 I —810 1 CONTRACTOR EMAIL: IV(CwJci(bat v►ia I I I. Cc)..•-, CONTRACTOR LICENSE#(REQUIRED): kv R R0c.J Ff g 17 PJL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CJC Z.,3 PRIMARY CONTACT: ❑ OWNER ®CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: //)..r_. 30/ _ g f 0 ? el So A) oJi `y CONTACT EMAIL: Ac/a,.,,Lfd/GCS ,ef 1. c 0+--. BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ LI, j 0 L--' Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: EINew ❑Addition ❑Remodel El Repair DTI. ❑Sign I Sprinkler El Demolition ❑Change of Use DESCRIPTION OF WORK: /n94// / frai-{c¢ (ate , A ql/ rc ,,. .to d aft—is unlit:A or t,'0ti- / ASSOCIATED BUILDING PERMIT#(if applicable): fL( 0 3•D!,Ga 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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Al 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# 7- to -/y-2v19I 4 1 0-w0 ', Owner/Authorized A Signature Date (Revised 4/15/2019) g (Liz )