1919 112TH ST SW 2024-02-27 - Laserfiche WebLink

� PERMIT APPLICATIO BUILDING3', MECHANICAL / PLUMBING / SIGN.PRINKLER / 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:1919 112th St SW PROPERTY TAX#:00537900003400 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Nationwide Health Properties TENANT BUSINESS NAME(Commercial): Everett Care & Rehab OWNER MAILING ADDRESS: STREET 1919 112th St SW CITY Everett STATE WA zip 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:Performance Mechanical Group CONTRACTOR ADDRESS: STREET 1012 Central Ave S CITY Kent STATE WA ZIP 98032 CONTRACTOR PHONE:425-251-0356 CONTRACTOR EMAIL:don.l@pmghvac.com CONTRACTOR LICENSE#(REQUIRED):PERFOHA15ORT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57268 PRIMARY CONTACT: ❑OWNER O CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-251-0356 CONTACT EMAIL:don.l@pmghvac.com BUILDING INFORMATION Existing Use of Building:Rehab facility Contract Price of Work: $30,200 Proposed Use of Building:no change Heat Source: OGas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑✓Repair ❑T.l. Sign Sprinkler Demolition ❑Change of Use DESCRIPTION OF WORK: Replace (1) 4-ton gas/pack, (1) 5-ton gas/pack, and (1) 125,000 BTU gas furnace with like. 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 2 A/C—Air Handling Units 3 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 II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems 1 Other:gas furnace 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,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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERT# L Don .. �.,.< 9/17/19 1,ctock‘ - l Owner/Authorized Agent Signature Date (Revised 10/10/2018) I /' 47