1902 LOMBARD AVE 2016-11-07 - Laserfiche WebLink

• • PERMIT APPLICATION BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: I gD 2 (�M(3� �}{/� PROPERTY TAX #: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNERNAME: �(�{ �{�(, TENANTNAME(IfCommercial): T/M 3 Cf��lC gOGiS�'�i�fi� OWNER MAILING ADDRESS: sTREET 352,(7 �A-IL� CITY STATE ZIP �g �-iJ I OWNER PHONE: �o—��-t�—�-t �O OWNER EMAIL: i1�ll�f D�{.� � Ow� t�li�-� �YYI CONTRACTOR NAME: TE� �R.� CONTRACTOR ADDRESS: sTReeT 1?J� � 5►T►) P L �E CITY �'��il Ll� STATE VMrJ ZIP `1$2ZD CONTRACTOR PHONE: 3�0(i " rI rI p— ZS] � CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): iQ�� g� OiD( CITY OF EVERETT BUSIN D): S��U PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 2,(,�p -�-8�--��/,Q I��K�-� �� CONTACT EMAIL: j'L)�l�c.101�- ��vp�C., Cd)'Y) BUILDING PERMIT APPLICATION Existin Use of Buildin : Contract Price of Work: $ V., l}li Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial T pe of Pro ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use DESCRIPTION OF WORK: Sh� w� P� � s�rn ��pCa c�n�t�,�- ASSOCIATED BUILDING PERMIT # (if applicable): PLUMBING PERMIT APPLICATION Type of Project: _New _Addn _Alteration Repair # of List of Fixtures # of List of Fixtures Fixtures Fixtures Toilet Backflow Preventer (Inside Bidg) Bathtub Urinal Lavatory (Wash Basin) Drinking Fountain Shower Floor Drain Kitchen Sink & Disposal Grease Trap Dishwasher Roof Drains Clothes Washer Medical Gas Water Heater Other: Sink (Service/Bar/Mop/etc.) Other: ACKNOWLEDGEMENT: 1 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 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � Agent Signature �'(�Ol�o Date City of Everett Official Use Only PERMIT� «o�- o ca (Revised 5/20/2016)