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, — • • <br /> 1 s i • I —_~`1'. <br /> WAI PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I SIGN/SPRINKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Pleas.) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6824 Beverly Boulevard Everett Washington 98203 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Kenneth Ormsby TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 6824 Bever <br /> ly yBoulevard <br /> crrr Everett STATE Wa ZP 98203 <br /> OWNER PHONE: (206)920-2091 OWNER EMAIL:KENNY0358@COMCAST.NET <br /> CONTRACTOR NAME: Specialty Contractors Northwest <br /> CONTRACTOR ADDRESS: STREET 17880 ne airport way v(ht <br /> c,T,. Portland STATE Or „P 97230 <br /> CONTRACTOR PHONE: 9712048111 CONTRACTOR EMAIL:hdinSallS@PaCifCbath.CO1 <br /> CONTRACTOR LICENSE#(REQUIRED):SPECICN843D3 CITY OF EVERETT BUSINESS LICENSE#(REQIARED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:9712462805 <br /> 1 Fallon Crawford CONTACT EMAIL:hdinstalls@homedepot.COm <br /> BUILDING INFORMATION <br /> Existing Use of Building: Residential Contract Price of Work: 1500 <br /> Proposed Use of Building:reSidential Heat Source: OGas [IElectric ❑other _ <br /> BUILDING USE: CISFR ❑Townhouse ❑Duplex LIADU ❑Multi-Family-#Units: OCommercial DAccessory Structure <br /> Type of Project DNew ❑Addition CIRemodel DRepair DT.l. DSign DSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: replace existing shower,vanity,toilet and floor with new-like for like,not moving any plumbing locations <br /> ASSOCIATED BUILDING PERMIT#(if a plicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Filth" <br /> List of Fixtures Fixture List of Fixtures <br /> Fixture List of Fixtures List of Fixtures Count Count <br /> Count count <br /> A/C-Air Handling Units Gas Piping -Backftow Preventer(Inside Bldg) 1 _Shower,Tub,or Combo <br /> �Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> thes Dryer Heat Pump&Ductless Dishwasher 1 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1 <br /> Toilet <br /> Exhaust Hood(Type I) ..(Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems [Other: Medical Gas Water Valves or Fixtures <br /> �—Gas Fireplace/Insert/Log <br /> it Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump other. <br /> Water Suppression System I INo.oof Headsteads - _ <br /> Chemical Suppression System No. _ <br /> ACKNOWLEDGEMENT.Ihave reviewed this application and confrrm 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 worts and no deviations therefrom.Deviations must first be authorized in wnfing from the <br /> Building Official before being authorized under any circumstance.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG, City of Everett Official Use Only <br /> PERMIT# <br /> ttj __) , <br /> C,C1C51 —CO c <br /> erlA thorized Agent S to tore <br /> D (Revised 10/10/2018. <br /> Scanned with CamScanner <br />