5711 10TH DR W 2019-07-09 - Laserfiche WebLink

PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everettcps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 5711 10th Dr NW PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Marsidi Ignatius TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4701 Gardner Ave CITY Everett STATE WA ZIP 98203 OWNER PHONE: Contact Cathy 425-308-3648 OWNER EMAIL: CONTRACTOR NAME: Nordstrom Heating &Air CONTRACTOR ADDRESS: STREET 4717 87th Ave NE CITY Marysville STATE WA ZIP 98270 CONTRACTOR PHONE: 360-386-9819 CONTRACTOR EMAIL: nordstromha@comcast.net CONTRACTOR LICENSE#(REQUIRED): nordsha975kh CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 042741 PRIMARY CONTACT: 0 OWNER fp CONTRACTOR 0 OTHER(Please Specify)_ CONTACT NAME: CONTACT PHONE: 360-386-9819 Debbie CONTACT EMAIL: nordstromha@comcast.net BUILDING PERMIT APPLICATION Existing Use of Building: _Contract Price of Work:$2578.00 Proposed Use of Building: Heat Source: ❑Gas DElectric DOther Building Type: ®SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial El Industrial Type of Project: ❑New ❑Addition ❑Remodel ®Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: like in kind furnace replacement ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of #of #of #of Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) 1 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 I SUPPRESSION SYSTEM7° 4 Chemical or Water IP 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. f City of Everett Official Use Only ' ( PEROvJ,�7�( \I\ L — \ `3 AD ,„,-/t(' , , ., .k C RMT 11 Owner/Authorized Agent Signature Date (Revised 9/23/2016)