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ENE PERMIT APPLICATiO <br /> 1112 <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN i SPRINKLER I DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov i www.everettwa.gov/permits <br /> (Blue<or.BlackInk Only Please) PROJECT SiTE,INFORMATION, <br /> PROJECT SiTE ADDRESS: 1814 Rockefeller Avenue,Apt.A,Everett WA 98201 PROPERTY TAX#:00438036702600 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .. CONTACT INFORMATION : .... <br /> OWNER NAME:Baldwin,Gerald R and Mary L TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1022 Oakes Avenue,Apt.1 <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: 360-303-2541 OWNER EMAIL: mary_baldwin@comcast.net <br /> CONTRACTOR NAME: Owner-Gerald(Gary)Baldwin <br /> CONTRACTOR ADDRESS: STREET 1022 Oakes Avenue,Apt. 1 <br /> crry Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE: 425-508-9125 CONTRACTOR EMAIL: gary_baldwin@comcast.net <br /> CONTRACTOR LICENSE#(REQUIRED): N/A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N/A <br /> PRIMARY CONTACT: &I/OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Gerald(Gary)Baldwin CONTACT PHONE: 425-508-9125 <br /> CONTACT EMAIL: gary_baldwin@comcast.net <br /> BUILDING iNP`ORMATION <br /> Existing Use of Building: Rental property Contract Price of Work:$ 2500 <br /> Proposed Use of Building: Heat Source: ❑Gas LrJElectric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex OADU IBMulti-Family-#Units: 4 ❑Commercial ©Accessary Structure <br /> Type of Project: CI New ❑Addition ORemodei 12'Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Replace existing electric hot water tank with gas on-demand tank and replacing electric dryer with gas dryer <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL:PERMIT APPLICATION PLUMBING PERMIT APPLICATION. <br /> Fixture Fixture , Fixture Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units 1 Gas Piping Backflow Preventer(Inside Bldg) Shower.Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> 1 Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System �No.of Heads. <br /> 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 <br /> 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 <br /> 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, <br /> and t comply with the State Contracto - aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> i'4-- -- 9,..1/(:) ....1/ PERMITyr r /,1 03 <br /> Owhoriz d Ag't-Igna ure Date (Revised 4/15/2019) <br /> /lei '�-1 L • �A-L bW i e <br />