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6 PERMIT APPLICATIOO <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: 26 81 ST ST SW, EVERETT, WA 98203 <br />PROPERTY TAX #: 00393500002106 <br />LEGAL for new construction: Short Plat/subdivision BEVERLY HOMESITES DIV1 Lot No. 6 (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Richard DucPhuoc Nguyen TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET26 81ST ST SW , EVERETT <br />CITY EVERETT STATE WA zIP 98203 <br />OWNER PHONE: 425-327-5920 <br />OWNER EMAIL: huynhvo08@gmail.com <br />CONTRACTOR NAME: LONG'S CONSTRUCTION <br />CONTRACTOR ADDRESS: sT1eET922 134TH ST SW <br />CITY EVERETT STATE WA ZIP 98204 <br />CONTRACTOR PHONE: 425-346-2071 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): LONGSC`006KP <br />CITY OF EVERETT BUSINESS LICENSE #(R U ED). co <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER (Please Specify) <br />CONTACT NAME: <br />Jacob Strobl <br />CONTACT PHONE: 206-661-3622 <br />CONTACT EMAIL:jacob@strobidesign.com <br />BUILDING INFORMATION <br />Existing Use of Building: Single Family Residence <br />Contract Price of Work: $ 133,100 <br />Proposed Use of Building: Single Family Residenc <br />Heat Source: OGas ❑Electric []Other <br />BUILDING USE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑✓ Addition []Remodel ❑Repair LIT.]. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: 1,100 sf main floor addition to existing single family residence <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 />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />3 <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />1 <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,flocr) <br />1 <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />4 <br />Sink -Residential (kitchen, bath, bar) <br />1 <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />3 <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />2 <br />Toilet <br />Exhaust Hood (Type 1) <br />1 <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />1 <br />Water Heater <br />Interceptor -Grease <br />WastelWater Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />1 <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT. 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />:urrenr 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 />Agent Signature <br />City of Everett OOfficialUse <br />OnOnly <br />l` C PE T ei F ^ J C�� <br />Date ' (Revised 1011012018) <br />G <br />