12420 21ST AVE SE 2019-06-12 - Laserfiche WebLink

41ETT PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES ORIGINAL 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: V it tl1 /'f 7—bp—r it/� ( E PROPERTY TAX#: 0\02,/,t/7120/ 5() LEGAL for new construction: Short Plat/subdivision rl V SE' Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Man (211/11)bir\ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET I2IZa 21 !qv?. SE- CITY 6cevG-1-4' STATE LOA ZIP ,926 OWNER PHONE: 1-125--i5-1 3172._ , T OWNER EMAIL: (ena i,nc \ @ . 4OL_ ,l(1,9 26? CONTRACTOR NAME: l v Flarrl-e �t r CONTRACTOR ADDRESS: STREET -1116 2,20 I" 9 U(„.0 #1 CITY 14 LT STATENawf Wt ZIP CONTRACTOR PHONE: r f 7,67------7-7 I'''7 lam' CONTRACTOR EMAIL: V I f OffJ{ �tC'a�CONTRACTOR LICENSE#(REQUIRED):�L(r/9i f � 6L CITY OF EVERETT BUSINESSLICENSE#(REQUIRED):z.--7 Q0 PRIMARY CONTACT: 0 OWNER 4TCONTRACTOR 0 OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: L` 1 I - (3q �mo V �krfe �it?. CONTACT EMAIL: nZ/ BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ rj 7•ilt Proposed Use of Building: Heat Source: ❑Gas ❑Electric CI Other Building Type: 'LISFR-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ,I�„4ddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: A/c mni1 \ 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 if of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC-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 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 lam 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 ROW and 296.200A WAG. I' City of Everett Official Use Only A 4.4'=141 ��G%Zj��l r'� PER 7\1 i 00• pi/, tign re Date (Revised 10/12/2015)