1223 LOMBARD AVE 2018-07-25 - Laserfiche WebLink

PERMIT APPLICATION BUILDING /MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES siiiii 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits , (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: /223 (_o 71-. ,bP('c PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: C.Gi %,z,A e ca r„/ r✓ TENANT NAME(If Commercial): lg"--- OWNER MAILING ADDRESS: STREET J7/ af�f— CITY k.)--e.re.../71—. STATE YV ZIP 9" _.--„©/ OWNER PHONE: VZ(s- 3 y-j—c3:2 ec=2 g OWNER EMAIL:' r CONTRACTOR NAME: /lair/ G&/`q qjf'� ” fl, Vl I J P/1AAnbi1'7j CONTRACTOR ADDRESS: STREET / 666 CITY STATE ZIP CONTRACTOR PHONE: 2Z'S- Q -- /95 CONTRACTOR EMAIL: Mkt h atr o#-ce) CONTRACTOR LICENSE#(REQUIRED):,4 4 of 1/P-' 9N45.---L? / CITY OF EVERETT BUSINESS LICENSE#(REQUIRED: C T PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please/ Specify) . CONTACT NAME: V.2-er CONTACT PHONE: r...2_5---- 9::.7--9 ei02 8' (4 j;v C'Zr°w N -555-.2+ 3 CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ i 50D. ° Proposed Use of Building: Heat Source: ❑Gas ❑Electric IF Other Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ommercial ❑Industrial Type of Project: ❑New DAddition DRemodel DRepair DT.I. ❑Sign ❑Sprinkler U De ion ❑Change of Use DESCRIPTION OF WORK: r sir 4 NIO//4tJiiJi%i ::.1/1 ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: /New _Addn _Alteration 71-Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bld5j Forced Air Systems Unit Heater 1 Bathtub Urinal Gas Piping Boiler 1 Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Draine) Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: I Clothes Washer Medical Gas Range Hood 1 Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER I SUPPRESSION SYSTEM Chemical or Water 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 1 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 C iG /z ^7____,,R07,9______ �- W1 /9 ,,,..,,ora, ,,,, _12 .___,,, v Owner/Authorized Agent Signature Date (Revised 9/23/2016)