16 FERN RD 2020-02-07 - Laserfiche WebLink

PERMIT APPLICATION BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLE' �' �,� ION EVERETT �/ 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/pe (Blue or:BlackInk Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:16 FERN RD, EVERETT, WA 98201 PROPERTY TAX#:28040100403300 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: DON BEEDLE TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREEr16 FERN RD cry EVERETT STATE WA ZIP 98203 OWNER PHONE:425-240-6762 OWNER EMAIL: GBEE59@HOTMAIL.COM CONTRACTOR NAME: EVERGREEN STATE HEAT&AC CONTRACTOR ADDRESS: STREET 2120 PACIFIC AVW my EVERETT STATE WA ZIP 98201 CONTRACTOR PHONE: 425-252-3114 CONTRACTOR EMAIL: LESLIE@ESSMWA.COM CONTRACTOR LICENSE#(REQUIRED): EVERGSSO22OT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 007955 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-252-3114 LESLIE CHAPMAN CONTACT EMAIL: LESLIE@ESSMWA.COM BUILDING'INFORMATION Existing Use of Building: Contract Price of Work:$5810 Proposed Use of Building: Heat Source: ❑Gas OElectric ❑Other BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ERepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: INSTALL SINGLE ZONE DUCTLESS HEAT PUMP 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 1 Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventiiatior 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-Sand/OII Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System INo.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. J ` City of Everett Official Use Only ej at V�-- - b { tc\ PERMI\#r n \ Oc �o Lk 1 � \'11 � G�. r- Ow41)\,N rized Agent Signature Date ff (Revised 10/10/2018)