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PERMIT APPLICATION <br /> ��� BUILDING I IUCHANICAL / PLUMBING /SIGN / INKLER� / DEMOLITION <br /> !'�"� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1820 Rockefeller Ave., Everett WA 98201 PROPERTY TAX#: 00437036702300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Rockefeller Rehab, LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO Box 2415 <br /> crry Kirkland STATE WA ZIP 98083 <br /> OWNER PHONE: 425-948-5356 OWNER EMAIL: lkeeper4me@gmail.com <br /> CONTRACTOR NAME: Chrysalis Homes, LLC <br /> CONTRACTOR ADDRESS: STREET PO Box 2415 <br /> CITY Kirkland STATE WA zip 98083 <br /> CONTRACTOR PHONE: 425-948-5356 CONTRACTOR EMAIL: lkeeper4me@gmail.com <br /> . <br /> CONTRACTOR LICENSE#(REQUIRED): CHRYSHL838J5 (0)31000/(k CITY OF EVERETT BUSINESS LICENSE#(REQUI-ED):*/ ' <br /> PRIMARY CONTACT: 0 OWNER l CONTRACTOR 0 OTHER(Please Specify) , ' l��R, <br /> CONTACT NAME: Mike Smith CONTACT PHONE: 425-948-5356 <br /> CONTACT EMAIL: 1keeper4me@Rmail.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Single Family Residential Contract Price of Work: $ 30,000 <br /> Proposed Use of Building: Single Family Residential Heat Source: 54Gas Elec lc ❑Other <br /> Building Type: I)SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Demolition of old finishes,plumbing,.elbetriesl;heating,sheetrock, interior finishes porch railings.roofing. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn x Alteration _Repair Type of Project: _New _Addn X Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 2 Bathtub Urinal <br /> 3 Gas Piping 1 Boiler 4 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration 1 Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> 1 Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> 1 Range Hood Other: <br /> 2 Exhaust Fan 1 ink Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' No. of Heads <br /> 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 <br /> 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 <br /> 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, <br /> and I comply with the State Contracto Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / /,/pr , PERMIT <br /> e -7--0-4-( z kq-Oq - °3(° ..„-- ,, <br /> Owner/Authorized Agent Signature Date (Revised 9/2372016)16) /i__ <br /> 3 <br />