6103 ROCKEFELLER AVE 2021-02-24 - Laserfiche WebLink

• PERMIT APPLICATION• BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION 1A.11:111010111111 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT�I SITE INFORMATION 41.PROJECT SITE ADDRESS: 6/0 3 �i OC ,{,N f CSC PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION 4 OWNER NAME: rN r09-f, O1'- TENANT BUSINESS NAME(Commercial): _ OWNER MAILING ADDRESS: STREET 7 / 4.} CITY /, i ' STATE 4 09- ZIP /4101PLia/ l_ OWNER PHONE: l — • 2635 OWNER EMAIL: //*A7 n ifriPtLjs ?1"-- �f , ylcq CONTRACTOR NAME: or-441 1Plr CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ,fOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTAClT AME: I _ CONTACT PHONE: 2126 4 76 2,3s J/€4" '�-#-t / 'c V—\ CONTACT EMAIL: ,�}4.0 ";ry 1•pyieIhrIS `�J— Co/rJG�'t�f' Ir/er BUILDING INFORMATION cx.T Existing Use of Building: Contract Price of Work:$ 00 0. Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: r e t r- Doe-al e?Ct hi A sc 4 d 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 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/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,s- : 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.- .e 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 -State'1 tractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only f 4 PERMIT \0 02— � Owner/Authorized Agent Signature Date (Revised 10/10/2018)