Laserfiche WebLink
ill <br /> PERMIT APPLICATION <br /> BUILDIN®ECHANICAL/ PLUMBING/SIGN /=INKLER/DEMOLITION <br /> EVERETTCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Pias) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:10529 4th Dr SE PROPERTY TAX#:00742900001400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Lawrence S Comella TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET2020 Maltby Rd Ste 7 PMB 294 <br /> crry Bothell STATE WA ZIP 98021 <br /> OWNER PHONE: 516-351-4491 OWNER EMAIL:Comella@me.com <br /> CONTRACTOR NAME: (UNE—la <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: a OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:516-351-4491 <br /> Larry Comella CONTACT EMAIL:Comella@me.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:I Family Home Contract Price of Work:$ 2-D©.Oc7 <br /> Proposed Use of Building:I Family Home Heat Source: Deas CIElectric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex EIADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ONew ❑Addition DRemodel @Repair DT.I. OSign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: Replace existing water line between utility shut-off and home. (There is no water meter,just a shut-off) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Rxture Fixture Fixture <br /> Count List of Fixtures Cour List of Fortunes Count List of Fixtures Count List of Fixtures <br /> 0 A/C—Air Handling Units 0 Gas Piping 0 Backflow Preventer(Inside Bldg) 0 Shower,Tub,or Combo <br /> 0 Boiler 0 Gas Range 0 Clothes Washer <br /> 0 Sink-Commercial(3-comp,prep,tloor) <br /> 0 Clothes Dryer 0 Heat Pump&Ductless 0 Dishwasher <br /> 0 Sink-Residential(kitchen,bath,bar) <br /> 0 Duct System(Remodel) 0 Refrigeration 0 Drinking Fountain 0 Sink-Utility,laundry,mop <br /> 0 Exhaust Fans(Residential) 0 Commercial Ventilatior 0 Floor Drain 0 Toilet <br /> 0 Exhaust Hood(Type I) (Not Heat/AC system) 0 Hose Bibb 0 Urinal <br /> 0 Exhaust Hood(Type II) 0 Water Heater 0 Interceptor-Grease 0 Waste/Water Piping Repair <br /> 0 Exhaust Hood(Residential) 0 Wood Stove 0 Interceptor-Sand/Oil 1 Water Service(behind meter) , <br /> 0 Forced Air Systems 0 Other: 0 Medical Gas <br /> 1 Water Valves or Fixtures <br /> 0 Gas Fireplace/Insert/Log 0 Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM 0 Sewage Ejector or Sump Pump Other: <br /> Water Suppression System 0No.of Heads <br /> Chemical Suppression System 10 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/am authorized by the owner of this property to perform the work for which application/s made, <br /> and I comply withthe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 72,2,/ ,/ City of Everett Official Use Only <br /> da <br /> l6/ / / PE���tO — o iC <br /> ,e,,,,,,,,:yOwnerlAuthorized Agent Signature Date (Revised 10/10/2018) <br />