10803 4TH AVE SE 2017-09-25 - Laserfiche WebLink

PERMIT APPLICATION BUILDIN&ECHANICAL/PLUMBING/SIGN /-OINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 10803 4th Ave SE, Everett, WA 98208 1PROPERTY TAX#: 0074400002000 LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Zebulon A Middleton TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10803 4th Ave SE CITY Everett STATE WA ZIP 98208 OWNER PHONE: 425-892-4914 OWNER EMAIL: nicholem@live.com CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: KOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-892-4914 Zeb Middleton CONTACT EMAIL: nicholem@live.com BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Puget Sound Energy will be installing gas from street to meter on side of house. Homeowner installed gas piping from meter to gas furnace in garage. PSE will not tum on gas flow until the homeowners piping is inspected. ASSOCIATED BUILDING PERMIT# if a plicable: MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: X New Addn _Alteration Repair Type of Project: —New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) 1 Forced Air Systems Unit Heater Bathtub Urinal 1 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 WRC. City of Everett Official Use Only 17 PER I 07/12/2016 F Oer/Authorized Agent Signature Date (Revised 5/20/2016)