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011 PERMIT APPLICATION* <br />EVERETT <br />WASHINGTON <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 1 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: 5111 Delaware Ave <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Skip Crout TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET5111 Delaware Ave <br />clTy Everett STATE WA ZIP <br />OWNER PHONE: Skip Crout <br />OWNER EM <br />CONTRACTOR NAME: Reed Hansen <br />CONTRACTOR ADDRESS: STREET4701 W Glenhaven Dr ft) 60 <br />cm. Everett STATE WA ZIP t '2j1 <br />CONTRACTOR PHONE: 425-343-9055 <br />CONTRACTOR EMAIL: rl hansen@icloud.net <br />CONTRACTOR LICENSE #(REQUIRED • (, 5 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRE d <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑✓ OTHER (Please Specify) Taylor Design Architects <br />CONTACT NAME: <br />Al Taylor <br />CONTACT PHONE: 360-540-8223 <br />CONTACT EMAIL: taylordesignarch@yahoo.Com <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ $30 000 <br />Proposed Use of Building: <br />Heat Source: ❑Gas ElElectric ❑Other <br />BUILDING USE: ❑� SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ©Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: add new front entry, add roof over rebuilt existing deck <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fxture <br />Count <br />f- <br />ListTfit Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Counf <br />List of Fixtures <br />A/C —Air Handling Units <br />Gas Piping <br />Back -flow Preventer (Inside Bldg) <br />Shower, =€u6; or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />$Mk -Commercial (3-comp,prep, floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential , <br />Commercial Ventilatior <br />(Not HeaUAC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) ; <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Re dential) <br />Wood Stove <br />Interceptor-Sand/Oil ' <br />Water Service (behind meter) <br />Forced Air Syst s <br />10ther <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplac nsert/Log <br />I <br />Roof Drains/ <br />Water Heater <br />SPRINK <br />R / SUPPRESSION <br />SYSTEM <br />Sewag jector or Sump Pump <br />Other: <br />Water Suppression System <br />INo. <br />of Heads <br />Chemical Suppression System <br />I <br />lNo. 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 witil the State Contractors Law 16.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PE # 2 A O <br />Dat Lv (Revised 1011012018) <br />