2111 JACKSON AVE 2021-11-15 - Laserfiche WebLink

PERMIT APPLICATION S LT BUlLDIN 1 MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION EVERETT CITY OF EVERETT 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: ? (1 1 ;)prc,K&bit) 1 U / 1 ) ,1T OPPROPERTY TAX#: 00c10-0 d,aqO P.a 00 LEGAL for new construction: Short Plat/subdivision Lot No. ('sttach copy of long legal description) CONTACT INFORMATION OWNER NAME: \,) ��}U t Cl 'TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: smEET 3 II).r} t !v cnv ott `.j so 1 c_ STATE -V / ZIP 1 0 , OWNER PHONE: /2 S _ a t- ® tor/ OWNER EMAIL: O\Pt/lc 9. Q.. CO`(A tc#-- I()C,1 CONTRACTOR NAME: 0W M-e.. �1 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ZKOWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: r CONTACT PHONE: y��— 3\— 0 t C)11'16 v ( ANCe CONTACTEMAAIL: C6 prN e (I G COAC&SA. ID 4UeT BUILDING INFORMATION Existing Use of Building: S t— Contract Price of Work:$ 4O, OOO ' -2- Proposed Use of Building: 6 F Heat Source: ❑Gas ElElectric ❑Other BUILDING USE: EI$FR DTownhouse ODupiex OADU ❑Multi-Family-#Units: DCCornrnercial OAccessory Structure Type of Project ❑New DAddition -Remodel ❑Repair DEL OSign OSprinlder DDemolfion ❑Change of Use DESCRIPTION OF WORK:lT 4 k �, l( c ,L.,y rS /�% J i y\A-Ce. w' lb �L't'xV1C. (J°e. 1r . A OCIIATED BUILDING PERMIT# if applicable): e MECHANICAL PERMIT APPLICATION _ ! PLUMBING PERMIT APPLICATION Fixture List of Fixtures >�revee List of Fixtures List of Fixtures Rxture Fixture List of Fixtures Count Count Count Count NC—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 Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type il) Water Heater Interceptor-Grease WasteNtiater 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 iChemical Suppression System 1 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, mply with the State Contractors Law 18.27 RCW and 296.200A WAC. aI City of Everett Official Use Only 1-- (�,i PER �02_, czg er/Authorized Agent Signature Dj 4-.' a---- c2 il i 2-024 o (Revised 10/10/2018) t q