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0 *-77. • PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 929 HOYT AVE. 98201 PROPERTY TAX#: 00385417501400 <br /> LEGAL for new construction: Short Plat/subdivision BAILEYS ADD TO EVERETT BL5 D1-005 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: RANDALL BURNS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer 929 HOYT AVE <br /> CRY EVERETT STATE WA ZIP 98201 <br /> OWNER PHONE: 425-210-6581 OWNER EMAIL: rbumualfo@aoLcom <br /> CONTRACTOR NAME: By Owner <br /> CONTRACTOR ADDRESS: STREET <br /> cm( STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR MOTHER(Please Specify) BLDG DESIGNER <br /> CONTACT NAME: ELAINE S.GROTH CONTACT PHONE: 425-876-4447 <br /> CONTACT EMAIL: Q.,.2 c4I WV L € <br /> BUILDING PERMIT APPLICATION ` el.1.. <br /> Existing Use of Building: single family residence Contract Price of Work:$ 801 OCCI,©G CtO <br /> Proposed Use of Building: single family residence Heat Source: LIGas ❑Electric °Other <br /> Building Type: 129SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: °Commercial ❑Industrial <br /> Type of Project: ❑New (2Addition ®Remodel °Repair ❑T.l. ❑Sign °Sprinkler ['Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Addition and remodel to EXISTING SFR,new electrical and heat pump,new roof <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New X Addn X Alteration Repair Type of Project: New X Addn X Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> NC—Air Handling Units q Heat Pump 2 Toilet Backtlow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> I Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration 1 Shower --1 rIe . Dr..:,e—. <br /> 2 Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> 1 Gas Range Ducting 1 Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups 1 Other: Dbq gas 1 Clothes Washer Medical Gas <br /> 1 Range Hood Other: <br /> A ✓ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER'/`SUPPRESSION SYSTEM <br /> 'Number 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply ' the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> , ' <br /> City of Everett Official Use Only <br /> CI 606-Ogg <br /> Owner/Authorized Agent Signature ate (Revised 5/20/2016) <br /> I <br />