2609 LOMBARD AVE B 2023-12-07 - Laserfiche WebLink

grr PERMIT APPLICATIO BUILDING , ECHANICAL/ PLUMBING / SIGN PRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT SITE ADDRESS: PROPERTY TAX#: Z(ob (A Low\b--•-rd g LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: —3 Z h 12..i-\TtY\Z h r TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET a O 1 (.0 (5�r0 4�) �-1 ii„'r CITY f. V Q--t' e tj ( -t(A STATE ZIP 7 2 rU i OWNER PHONE: `i 2-S 3 i 9 3 5 Z- OWNER EMAIL: J e- a n t 9 e-3 s-vi 3 V o e ., L-tf) CONTRACTOR NAME: p c.0 ,A.a r C 'i e d•K , CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: E -OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use DESCRIPTION OF WORK: - A�� Gas ' ,'��6�v �i X�icr�°S sccf�e tfvc / J . ASSOCIATED BUILDING PERMIT#(if applicable} # ru r `-e I: #A / d I i-¢ c l--VQ I-- (z`), 4- k e a iv‘,' -A-IS MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures _ _A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems _ Unit Heater Bathtub Urinal 1.,—. .4' Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap _Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups - Other: Clothes Washer Medical Gas Range Hood Water Heater Other: E haust Fan Sink(Service/Bar/Mop/etc.), Other: ?2 £i t 4 a,.. 0?i rt-I Vi&.sf SPRINKLER!SUPPRESSION SYSTEM Number 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# 5.--e-____---N1 • Al zCrzv/ (�llU(o 020 Pl- lrl,- Owner/Authorized Agent Signature Da e (Revised 10/12/2015)