3716 ROCKEFELLER AVE 2019-11-07 - Laserfiche WebLink

#111111 RMIT BUILDIfJUII11ECHANICALEI PLUMBING I SIGN RINKLER 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) PROJ CT nnSITEINFFORMATJO PROJECT SITE ADDRESS: 23'71 y 1Oc 1 la / t____611 f OPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) _ CONTACT INFORMATION OWNER NAME: f k avn 45 /l� c1 W h S9-r TENANT NAME(If Commercial): 9-n OWNER MAILING ADDRESS: STREET jnG 3/i /.J - —d Ao L crrT 4+,—,1,e- Y STATE tik- ZIP 9 72.0/ OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ' 0¢x/t- CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: t OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: L'\,17--,i,---) CONTACT PHONE: 6 793 5'3 `7014445 . l CONTACT EMAIL: BUILDING PERMIT APPLICATION / Existing Use of Building: Contract Price of Work:$ –; MOO.°; .-1– Use of Building: VV.-,i 9,41,61-A 1 Heat Source: Glias ❑Electric DOther Building Type: ❑SFR-Detached ❑SFR-Attached DDuplex ❑Multi-Family#of Units: CI Commercial ❑Industrial Type of Project: CI New OAddition CI Remodel DRepair DTI. DSign DSprinkler DDemolition DChange of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New_ Addn 1k 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 I Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler d 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. I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. SPRINKLER/SUPPRESSION SYSTEM. Chemical or Water I 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 ofEEverett Official Use Only '. / / � S�_ I JPEl1Qj Owner/Authorized Agent Signature Date (Revised 9/23/2016)