4624 HARBOR LN 2021-11-12 - Laserfiche WebLink

PERMIT APPLICATIOI 11,11 BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:4624 Harbor Lane, Everett PROPERTY TAX#:00417100000602 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Tim Brown TENANT BUSINESS NAME(Commercial): NA OWNER MAILING ADDRESS: STREET4624 Harbor Lane CITY Everett STATE WA ZIP 98203 OWNER PHONE: 425-362-8477 OWNER EMAIL:tim_b_brown@yahoo.com CONTRACTOR NAME:owner CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: D OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-362-8477 Tim Brown CONTACT EMAIL:tim_b_brown@yahoo.com BUILDING INFORMATION Existing Use of Building:Single Family Residence Contract Price of Work:$$3,000 Proposed Use of Building:Same Heat Source: OGas ❑Electric ❑Other_ BUILDING USE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure Type of Project: ONew ❑Addition ®Remodel ✓❑Repair DT.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Remodel (shower walls, shower valve, replace sink, , ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures court List of Fixtures Count List of Fixtures Count List of Fixtures NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) I Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher I Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/`SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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 Building Official before being authorized under any circumstance.lam the owner,or/am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 7 RCW and 296.200A WAC. City of Everett Official Use Only Il,%2c TT 034_ (Twner/Authorized Agent Signature Date (Revised 10/10/2018)