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4177 PERMIT APPLICATIOr <br /> BUILDING i MECHANICAL / PLUMBING /SIGN I oPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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:4600 Baker Drive PROPERTY TAX#:00417400001400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Tom Jones TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET4600 Baker Drive <br /> CITY Everett STATE WA ZIP 98203 <br /> OWNER PHONE: OWNER EMAIL:tWjones3@gmail.com <br /> CONTRACTOR NAME:TBD \3 Wu_ IV 00 n \IN.)00 �-S L L <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): U L VL C. M AA W 06 MA- <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR D OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE:425-242-0369 <br /> J3 Architects- Neil Jorgensen CONTACT EMAIL:neil@j3-llc.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:Residential Contract Price of Work:$5SY960— 'SbOO. - <br /> Proposed Use of Building:Residential Heat Source: OGas DElectric ❑Other <br /> BUILDING USE: DSFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑✓Addition ❑✓Remodel ❑Repair ❑T.I. ESign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ADDITION: 214 SF ADDITION TO EXIST. SINGLE FAMILY RESIDENCE, 290 SF COVERED DECK <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixt List of Fixtures List of Fixtures <br /> Count Count Count Count s <br /> A/C—Ai andling Units Gas Pipi Backflow Preventer(Inside Bldg) 1 Shower,Tub,or Combo <br /> Boiler 1 •Gas. ange 1 Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> 1 Clothes Dryer at Pump&Ductless 1 •Dishwasher 2 Sink-Residential(kitchen,bath,bar) <br /> Duct System(Re del) 1" Refrigeration Drinking Fountain 1 Sink-Utility,laundry,mop <br /> Exhaust Fans(Resi ntial) / Commercial Ventilatior Floor Drain 1 Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) 1 Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> 1 Exhaust Hood(Res' ntial) ` Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Syst s Other: Medical Gas Water Valves or Fixtures <br /> Gas Firepla nsert/Log Roof Drains <br /> SPRIN R/ SUPPRESSION YSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppress " n 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 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 /> 01.26.21. IT,1 I 6 "4' b30 <br /> Owne Authorized Agent ignature Date (Revised 10/10/2018) <br />