2111 JACKSON AVE 2021-11-15 - Laserfiche WebLink

PE: ATION 11 En BUILDING 1 MECHANICAL I SIGN/SPRINKLER/DEMOLITION EVERETT CITY OF • - TT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (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) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: t f .'+ :k cap) 4 ce r l;i�.ec,tt, U Pr . PROPERTY TAX*: y)(�s1.30., 4/022°0 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ROVIact 6-ctiocAe. TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 3141 c I s' OE cm ' INA"4Y1I,S1/4•%,,-\lZ., STATE ( i,)er ZIP cie,770 OWNER PHONE: (i;).S--' 31'- O t b1 OWNER EMAIL: t ,q.,r qE "T ci pic,i S k. . e,4 CONTRACTOR NAME: 0 ki NC-(-. • CONTRACTOR ADDRESS: siRaur CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: KOWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: V10 CV " C'. CONTACT PHONE: i- f - ca.3\ 0 k 0 I CONTACT EMAIL: CA A.A)c e_ ` e' al 451 A-) -V BUILDING INFORMATION 1 Existing Use of Building: 6 F g Contract Price of Work:$ lilt r S(� '- Proposed Use of Building: 6 F % Heat Source: OGas ®Electric DOther BUILDING USE:ZOFR OTownhouse DDuplex DAM) DMurti-Family-#Units: OCommercial DAccessory Structure Type of Project ONew OAddition Egemodel ❑Repair OIL OSign OSprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: urok'c.: ext sA.w.3 aiu�AA..‘INv&c3 4- fkjc•4.044.3 ASSOCIATED BUILDING PERMIT#(if applicable): t MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture List of Fixturesxaayr List of Fixtures l�xtrr>a List of Fixtures Fixture List of Fixtures Count Count Cou, Count NC-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) f Shower,Tub,or Combo Boiler Gas Range I Clothes Washer Sink-Commercial(3-comp,prep,floor) lothes Dryer Heat Pump&D • ess 1 Dishwasher 3 Sink-Residential(kitchen,bath,bar) D . System(Remodel) Refrigerati. Drinking Fountain Sink-Utility,laundry,mop Exhau _ ans(Residential) Corn - cial Ventilatio Floor Drain . Toilet F_ tiaust H.•. (Type I) ( eat/AC system) a Hose Bibb Urinal Exhaust Hood ' •- II) 1 . ater Heater Interceptor-Grease ! Waste/Water Piping Repair Exhaust Hood(R- ential) 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 .2 Water Heater SPRINKLER I SU: 'RESS : . SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System Noeads ,Chemical Suppression Sys -• I No.of Heads ACKNOWLEDGEMENT: ave 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. I. City of Everett Official Use Only Signature �Owner/Authorized AgentDat (Revised 9 �� 10/10/2018)