12728 19TH AVE SE DR MARK STIVERS 2019-06-11

477". PERMIT APPLICATION BUILDING :CHANICAL I PLUMBING / SIGN 1 tINKLER I 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 (Blue or Black Ink Only Please) R E T 1 INFORMATION PROJECT SITE ADDRESS: Q.-lab -- �° PROPERTY TAX#: Z2765 oct)400 icc) LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: v i1\ 1j i OY,-.1 L15j LEI' TENANT NAME(If Commercia : 112. 1•111,0.4 `moi 1 VC-Z--) 1 OWNER MAILING ADDRESS: STREET 1OOS1 2 i9 4I L; `>2:.:,-- >iJt s n c� CITY j� STATE w., ZIP IL OWNER PHONE: 4Z5-3 i — Z2244 IOWNEREMAIL: wilaySZo\A„ LE LEYe' 6:6M.)L.. cJbM CONTRACTOR NAME: Ac---E F;)2L- t L.L.te CONTRACTOR ADDRESS: STREET P c 1-L-LJ)<< ZL)L: _-- CITY F.ka c}-t- \ STATE L.--i,-- zip 9 S CONTRACTOR PHONE: 201.4 549-in 5 CONTRACTOR EMAIL: AEFper��N'4-,y`.*-►S,Ccci-4 /L�1ccjj, NL; CONTRACTOR LICENSE#(REQUIRED):ACC-1:4F- 70 2?M CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) t. (56g2,O q PRIMARY CONTACT: 0 OWNER j�CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2,OL.)- j4`j- 1 1 - r> 9�12 CONTACT EMAIL: ACa_)-1Q 5y +�1S ( c_ _4 A`5c. 1.:).E.-.r BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ r.', Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: &Commercial El Industrial Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign .I Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ac-Coca i L= g &i.-.)!:> or1=A:>s F.-..)(2_ E-_--N,Q -1-.)_ CL-(7‘ ASSOCIATED BUILDING PERMIT#(if applicable): 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 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: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: - SPRINKLER/SUPPRESSION SYSTEM Chemical or Water ' „. I z 1 No. of Heads ACKNOWLEDGEMENT:I have review d 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. Th 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 nder any cir91mstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made. and/comply with the State Contractors L 8.27 OW and 296.200A WAC. am— City of Everett Official Use Only Z,61 - 7.46/ 7 71-# Owner/Authorized Agent Signature Date (Rev sed 9/23/2016)