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PERMIT APPLICATION" <br /> BUILDIN ECHANICAL / PLUMBING / SIGN 111111PRINKLER/ 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: 9030 4TH PL SE, EVERETT, WA 98208 PROPERTY TAX#:00402600001400 <br /> LEGAL for new construction: Short Plat/subdivision N/A Lot No. 14 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: HUYNH LEHANG TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET615 75th ST SE #C36 <br /> CITY EVERETT STATE WA zrP 98203 <br /> OWNER PHONE: 425-309-9872 OWNER EMAIL:hanghuynh1972@hotmail <br /> CONTRACTOR NAME: Owner <br /> CONTRACTOR ADDRESS: STREET <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: Z/CI - :2— <br /> ? <br /> Le_3 Wit i i, �� <br /> CONTACT EMAIL: N- 1Y�� s 1'�t13 te'h,)�ceL f7�.iv� <br /> BUILDING INFORMATION <br /> Existing Use of Building: ,A'r -. 5 f Contract Price of Work: $,5'CS/ COO i• 0 <br /> Proposed Use of Building: f..1 b`,yt, 5 F d\ Heat Source: DGas PElectric ❑Other <br /> BUILDING USE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Adding a bathroom, remodel kitchen, update electrical and plumbing and adding 2 car garage.1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> CFxtureount Fixture <br /> List of Fixtures Fixture List of Fixtujps <br /> Count Count <br /> List of Fixtures List of Fixtures <br /> Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) 2 Shower,Tub,or,p6mbo <br /> Boiler > Gas Range 1 Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> 1 Clothes Dryer ,-. Heat Pump&Ductless 1 Dishwasher 3 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel)�/,./ ) Refrigeration Drinking Fountain f Sink-Utility, laundry, mop <br /> Exhaust Fans(Resideot l), Commercial Ventilatior Floor Drain $ ' Toilet <br /> Exhaust Hood(Type 14. (Not Heat/AC system) Hose Bibb 1("i Urinal <br /> Exhaust Hood(Type d) 1 Water Heater Interceptor-Grease ,:-.1, Waste/Water Piping Repair <br /> 1 Exhaust Hood(Residential) Wood Stove Interceptor-Sand/O17)V Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains 1 Water Heater <br /> SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads j <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 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 /> City of Everett Official Use Only <br /> .( <br /> PERMIT# <br /> t / t .'\J \9-0 (.-4..; 7,-70 Z.----oo 7 <br /> Owner/Authori d A e Signature Date (Revised 10/10/2018) <br />