4902 BLACK FOREST LN 2017-02-27 - Laserfiche WebLink

PERMIT APPLICATION BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEMOLITION '11PAI "--A CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (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:4902 Black Forest Lane PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Grant Phillips TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4902 Black Forest Lane CITY Everett STATE WA ZAP 98203 OWNER PHONE: 4257500979 OWNER EMAIL: daka999@comcast.net CONTRACTOR NAME Axiom HVAC CONTRACTOR ADDRESS: STREET 2232 Broadway, Suite 101 CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE: 4258795351 CONTRACTOR EMAIL:daron@axiomnw.com CONTRACTOR LICENSE#(REQUIRED): AXIOMH 1892RM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D 94��y PRIMARY CONTACT: 0 OWNER WI CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4258795351 Daron Smith CONTACT EMAIL:daron@axiomnw.com ...................... BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ vv Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: /T4SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project:'❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: /� � � F9 ( � ► r� ASSOCIATED BUILDING PERMIT#(if applicable): �-\ P (1 `'") ( i I✓`) f"l 4 G l , MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration Repair Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) / Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM !Number 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 t/ _ � PERMIT# 1 A. ( 70I - OD Owner/Authorized Agent Signature Date (Revised 9/23/2016)