12303 21ST AVE SE 2019-08-13 - Laserfiche WebLink

MIN PERMIT APPLICATION MI BUILDING / MECHANICAL/ PLUMBING / SIGN IJW RINKLER/ DEMOLITION E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: I22 O.) J 1 S d l C S PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: GA/ L A.AkjV" >vt/i-n//✓ TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET E1r-+ `1 CITY STATE ZIP OWNER PHONE: LIZ 5-- 2(iii--- 3(a—) OWNER EMAIL: CONTRACTOR NAME: PILL f et A G.),ti.D C ec NO. F-U -" - qf 1 L CONTRACTOR ADDRESS: STREET IF-2 0 I 6(0 4- `1 /t cm( )(f A)o, J''.,C. (// 7 - sr( c../). c �r (Pvt.,' / cC i l(C� BD�rt.�7f{ Y , 4jii-e.ir.1( 6icY2.cpwl CONTRACTOR PHONE: 2 C b"- botl._ 001 Z CONTRACTOR EMAIL: ,/9LC i`7�1 C.0.0c vrt. ACioto f'1. Ctn�CONTRACTOR LICENSE#(REQUIRED): ILUEC(2rP j) C(' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 , ,) PRIMARY CONTACT: 0 OWNER deCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 5 A `i M CONTACT EMAIL: S/3 et"L. BUILDING INFORMATION Existing Use of Building: A c-O Contract Price of Work:$ I a 19 v Proposed Use of Building: Heat Source: Das ❑Electric ❑Other BUILDING USE: LFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition C 'Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ee(a.c{ 1-11Arnae_e i Al e ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures GNC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease,, Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-S rid/Oil Water Service(behind meter) V Forced Air Systems Other: Medical s Water Valves or Fixtures Gas Fireplace/Insert/Log Ro rains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System 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 I am authorized by the owner of this property to perform the work for which application is made, and I coma r with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only I f PERMIT# 01—1(- ' M 1 cM7-4S6 Own r//Authorized Agent Signature Date (Revised 4/15/2019)