12906 19TH AVE SE 2023-04-07 - Laserfiche WebLink

ill PERMIT APPLICATION in BUILDING /MECHANICAL/PLUMBING/SIGN /SPRINKLER/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:1acto k, o} „_gkiarelr .1- =51nLrty PROPERTY TAX#:.2$0.5300nq0(,,a00 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:F(.R GI \e y Q. S j-0 Q-S .TN C TENANT BUSINESS NAME(Commercial): E(a 61, ynQ 1.2J 5 OWNER MAILING ADDRESS: STREET I 01 Ai Vism e sT (,Ij G:NAzr'f O l4,'O , rv1 CITY (. C 1/V A/A'-V. STATE ( \ t_C) ZIP 1 S,ao OWNER PHONE: 100^S - L z 77 OWNER EMAIL: CONTRACTOR NAME: 14 dl U L2& S le ,iJ CONTRACTOR ADDRESS: STREET 1 3 7 4--`"' >i A) t" c„ q Q^ CITY A k,b,fri W STATE A ZIP 1 O e(3 1 CONTRACTOR PHONEac2,-925 7- S9 0 a CONTRACTOR EMAIL: 0‘,SL, Pe h1 I A- Q icvl/b9.i • C.0"'I CONTRACTOR LICENSE#(REQUIRED):AVANLCLX3 A Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 15V.CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ,DS-3 r 9,5.7- 5 9 p et --% 9A) Toy, or CONTACT EMAIL: G .„ /„, 4zvs,,►,: -'T C3-v-,A- L, Co BUILDING INFORMATION Existing Use of Building: C O Av,,...se.C‘<J: A-\ Contract Price of Work:$........24 00 O Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Famil #Units: 6ommercial ❑Accessory Structure Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. aieign ❑Sprinkler ❑Demolition OChange of Use DESCRIPTION OF WORK: Al Sl-�` ` CI, IJ Le p WA 1\ S,�5 N s +0 '5 +y dcl C- CC(A•J k S te:N� 1e-\yS S¢N-s o 1A W�.eR vi-c,ea J 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-com1,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 Ventilator 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 I 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 298.200A WAC. City of Everett Official Use Only PER2.651 a.OM r/Authonzed Agent Signature Date (Revised 10/10/2018)