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MIMI • PERMIT APPLICATION • <br /> Ira <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (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:1020 Hoyt Avenue PROPERTY TAX#:00385421502600 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Jordan Stephens TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1020 Hoyt Avenue <br /> clrr Everett STATE WA ZIP 98201 <br /> OWNER PHONE: Jordan Stephens - OWNER EMAIL: a cc° ���.-A �b�:. <br /> CONTRACTOR NAME:Unknown at this me. -�n� ' <br /> CONTRACTOR ADDRESS: STREET \_ --.Hook- / <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 sk;)3 5. - 3 7?J <br /> Jordan Stephens CONTACT EMAIL:,54S k-tc -sr.e_t\4-@ C' ^c7.�`.w'Cr--0hv." QJ' \c - . <br /> cc r <br /> BUILDING INFORMATION <br /> Existing Use of Building:Residential _Contract Price of Work:$Approximately 50,000.00 <br /> Proposed Use of Building:Residential Heat Source: IZIGas ❑Electric ❑Other <br /> BUILDING USE: IZISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair ❑T.I. ❑Sign LiSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Remodel of kitchen and powder room. Replacement of window with door and gaurdrail. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION ---% <br /> Fixture Fixture Fixture \ Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count ist of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow`Preventer(Inside Bldg) Sh er,Tub,or Combo <br /> Boiler 1 Gas Range Clothes Washer `. ink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher --... 2/ Sink-Residential(kitchen,bath,bar)Duct System(Remodel) ,^1�_ e io`—�1 Drinking Fountain Sink-Utility,laundry, mop <br /> li) <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 1 -TOiie <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping <br /> 1 Exhaust Hood(Residential) Wood Stove Interceptor- fid/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medi Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Rob&Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 Officia 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 ith the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only/P MIT# I/ l/ L <br /> . Ow r/ uthorizecrAge rgnature Date (Revised 10/10/2018) <br /> ty2010 ' 1 D <br />