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grr PERMIT APPLICATIOI <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / 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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6610 GATEWAY TERRACE PROPERTY TAX#: 006120-000-034-03 <br /> LEGAL for new construction: Short Plat/subdivision WESTWOOD/SP1202 99-030 Lot No. 1 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ENRIQUE & MARIA DELEON TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6610 GATEWAY TERRACE <br /> CITY EVERETT STATE WA zip 98203 <br /> OWNER PHONE: 425-346-0828 OWNER EMAIL: <br /> CONTRACTOR NAME: KUSTOM--US, INC:- �Cte "� OV\S <br /> CONTRACTOR ADDRESS: STREET 7733 V1 BOSTIA -RD, T1=1=$ <br /> CITY WOODINVILLE STATE WA ZIP 9 <br /> CONTRACTOR PHONE: 425-892-1901 CONTRACTOR EMAIL: 1A0- -S14‘ ) <br /> ` ,(,y�. ,{ <br /> CONTRACTOR LICENSE#(REQUIRED): `KUSTOUI847NO CITY OF EVERETT BUSINESS LICENSE#(REQUI D): -C)41-- <br /> - <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Specify) STRUCTURAL ENGINEER <br /> CONTACT NAME: CONTACT PHONE: 425-318-6049 <br /> JEFF GILLILAND, SE CONTACT EMAIL: JEFF@GKSTR CTURAL.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SFR Contract Price of Work:$ 125,0 1.-�—' <br /> Proposed Use of Building: SFR Heat Source: OGas ❑Electric" ❑Otter <br /> Building Type: QISFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition ❑Remodel VRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> fire damage repair (repl roof trusses, gut & refinish interior, all repairs match exist), convert 1/2 garage to rec room <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration /Repair Type of Project: _New _Addn _Alteration I 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 /> I Forced Air Systems Unit Heater 3 Bathtub Urinal <br /> Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove ( Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting i Dishwasher Roof Drains <br /> II Clothes Dryer Hookups Other: ( Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Li Exhaust Fan Sink(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/com<,y with the State Cly a••rs Law 18.27 RCW and 296.200A WAC. <br /> /� City of Everett Official Use Only <br /> '` //�� -�— PER 1 # <br /> �:, ., %ice S zzI 7Ag0c — D0� <br /> r p �'e'•nt Signature D e (Revised 9/23/2016) <br /> )/-1/ <br />