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PERMIT APPLICATION <br /> � BUILDINI 1ECHANICAL/ 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: 1202 Grand Avenue PROPERTY TAX#: 00409422501400 <br /> LEGAL for new construction: Short Plat/subdivision The Heights Addition Lot No. 14,15.16 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Dan and Shannon Leach TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1202 Grand Avenue <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME Concept Builders Group <br /> CONTRACTOR ADDRESS: STREET 1627 208th Street SE <br /> CITY Bothell STATE WA ZIP 98012 <br /> CONTRACTOR PHONE: 425-770-6592 CONTRACTOR EMAIL: casey©conceptbuildersgroup.corn <br /> CONTRACTOR LICENSE#(REQUIRED): CONCEBG912NF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR V OTHER(Please Specify) Designs Northwest Architects <br /> CONTACT NAME: CONTACT PHONE: 360-629-3441 <br /> Tom Rochon or William Lippens CONTACT EMAIL: tom@designsnw.com, bill@designsnw.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:SFR Contract Price of Work: $ <br /> Proposed Use of Building: SFR Heat Source: { Gas ❑Electric ❑Other <br /> Building Type: IISFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New IZAddition I1Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Addition of a single car garage with two bedrooms and a bath above. Remodel of the second floor open area and bath. Conversion of a detached single car garage into an attached storage 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 4Addn ,(Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> NC—Air Handling Units Heat Pump / Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater S Bathtub Urinal <br /> Gas Piping Boiler 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 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> AV/1r— PERMIT# (e.__\„) i(?) D <br /> Owner'7 horiz'd Agent-"sr-at Ire Date (Revised 9/23/2016) <br /> t 1 <br /> 2 <br />