10127 21ST AVE W 2023-06-22 - Laserfiche WebLink

PERMIT APPLICATIO BUILDING ECHANICAL/ PLUMBING /SIGN 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: 10/ ,t .Y 2 l44 A l/' kV PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision E Pep ./ NSA W2440. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: /tY10-/4Q/? TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET to/2 • I '-f Ave )/// t-1/E2 e 4-t CITY 0/4- STATE /L�2O"/ ZIP OWNER PHONE: 2 s2 l C/ OWNER EMAIL: /Va i/1 l<1U t P7et4 e YakOC)• C 1)/17 CONTRACTOR NAME: /1/2.2 CONTRACTOR ADDRESS: STREET 1p-(2 27' Aj/e YV re i CITY STATE �W� ZIP CONTRACTOR PHONE: ,Z j CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: tiOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION r� Existing Use of Building: Contract Price of Work: $ 2 t;S Cct./ C Proposed Use of Building: Heat Source: / Gas CJElectric ❑Other BUILDING USE: ❑SFR ❑T nhouse ❑Duplex ❑ADU L]Multi Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: Li Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 714r Pfa f %'i /L opeL --r-d &i/wo s A Po/noA , 77-ro . k.O P ASSOCIATED BUILDING PERMIT#(if applicable): *I " ttqf2 • G p L 41,201„ 1; t MECHANICAL PERMIT APPLICATION iliLUMBItIG PERMIT APPLICATION Fixture Fixture ure 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 41' 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) Forted 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 t e State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT#/9////// w 50 7 —;291, •: • -:Agent Signature Date (Revised 1.00,006C3A .� /�� (1/1Th