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PERMIT APPLICATION <br /> / / BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> A411rCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or.Black.:ink Only Please) PROJECT-SITE-#NFQI ATION s< • � - <br /> PROJECT SITE ADDRESS: 2409 W Mukilteo Blvd PROPERTY TAX#: 004170002013000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION✓'`,. ,., :{s a <br /> OWNER NAME:Tristan Mounsey TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 926 3rd St <br /> ciry Mukilteo STATE WA ZIP 98275 <br /> OWNER PHONE: (425)802-7593 OWNER EMAIL: tristan.mounsey@gmail.com <br /> CONTRACTOR NAME: Blackwood Builders Group LLC <br /> CONTRACTOR ADDRESS: STREET 15620 Hwy 99, Suite 17 <br /> CITY Lynnwood STATE WA 21P 98087 <br /> CONTRACTOR PHONE: (206)276-9275 CONTRACTOR EMAIL: aaron@blackwoodbuildersgroup.com <br /> CONTRACTOR LICENSE#(REQUIRED): BLACKBG862B2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)641(L Ct <br /> PRIMARY CONTACT: 51 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (425)802-7593 <br /> Tristan Mounsey CONTACT EMAIL: tristan.mounsey@gmail.com <br /> ___:13U1tbi 'PERMIT APPi.IGATiON W <br /> Existing Use of Building: Single Family Contract Price of Work:$ 70,000 <br /> Proposed Use of Building: Single Family Heat Source: ®Gas ❑Electric ❑Other <br /> Building Type: 0SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ®Addition ®Remodel ®Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Residential remodel and small addition. See attached plans for details. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 'MECHANICAL-PERMIT,APPLUCA"IA E PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _LAddn _Alteration . Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> 3 Gas Piping Boiler 2 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration 1 Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> 1 Gas Range in Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> 1 Range Hood i ,tea ere— Other: <br /> Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER) SUPPRESSION SYSTEM <br /> Number 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 wi. he State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#(1. C OO ` <br /> 63///2,c) 1 /- <br /> Owner/Author' d Agent9 Signature Da4e (Revised 5/20/2016) <br />