2110 ROCKEFELLER AVE 2019-09-24 - Laserfiche WebLink

4" PERMIT APPLICATION BUILDING / MECHANICAL / PLUMBING /SIGN / SPHINKLER / 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 Inky-Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:2110 Rockefeller Avenue, Everett, WA 98201 PROPERTY TAX#:004370-436-028-02 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Michael List TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: sTREET2110 Rockefeller Avenue CITY Everett STATE WA ZIP 98201 OWNER PHONE: 425-446-9506 OWNER EMAIL:list.michaelOoutlook.com CONTRACTOR NAME:N/A - same as owner CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-446-9506 Michael List CONTACT EMAIL:list.michaelC outlook.com BUILDING INFORMATION Existing Use of Building: Contract Price of irk:$ Ct5-0 - - Proposed Use of Building: Heat Source: ❑.-s 0 - - ■Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ElAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Replacing old galvanized steel water supply lines with PEX plumbing 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 A/C—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 Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease �z Waste/Water Piping Repair Exhaust Hood(Residential) _Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems _ Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER I 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only CI( lee/ ., e7 ---------- 1V24 ( ?o1 �#5� C2 -0[. 2, Owner/Authorized Agent Signature Gate l (Revised 10/10/2018)