4918 BLACK FOREST LN 2019-01-17 - Laserfiche WebLink

PERMIT APPLICATION BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE ADDRESS:4918 Black Forest Ln PROPERTY TAX#: 29053100308600 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) OWNER NAME: Karl Hansen TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREET4918 Black Forest Ln CITY Everett STATE WA zip 98203 OWNER PHONE:425-259-1916 OWNER EMAIL: CONTRACTOR NAME:WASHINGTON ENERGY SERVICES CONTRACTOR ADDRESS: STREET 3909 196TH ST SW clrr LYNNWOOD STATE WA ZIP 98036 CONTRACTOR PHONE:206-378-6648 CONTRACTOR EMAIL:vstephenson@Washingtonenegy.com CONTRACTOR LICENSE#(REQUIRED):WASHIES851 NS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54773 PRIMARY CONTACT: 0 OWNER ECONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-378-6648 Vanessa Stephenson CONTACT EMAIL:vstephenson@washingtonenergy.com Existing Use of Building: Contract Price of Work:$__ Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached muplex ❑Multi-Family-#of Units: OCommercial ❑Industrial Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): 11111:1:04:Y.WAS:::PEROMZISIMMIlla Z1!711111171F: Type of Project: _New _ Addn Q Alteration _Repair Type of Project: _New _Addn I Iteration _Repair #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handlin• Units —Heat Pump —Toilet —Backflow Preventer(Inside Bld•) Forced Air S stems —Unit Heater —Bathtub —Urinal Gas Pi•in• —Boiler —Lavato Wash Basin —Drinkin. Fountain 1 Water Heater —Refri•eration —Shower —Floor Drain Gas Fire.lace —Wood Stove ®Kitchen Sink&Dis•osal Grease Trap Gas Ran•e —Ductin• Dishwasher Roof Drains Clothes D er Hooku•s Other: a Clothes Washer —Medical Gas Ran•e Hood —Water Heater —Other: Exhaust Fan —' —Sink Service/Bar/Mo./etc. —Other: IINK >.ER UPP �■ Number 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.1 am the owner,or lam authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Vanessa Stephenson trigirid, -0 "°" 11/10/17 ////Y\ , Lk/2 Owner/Authorized Agent Signature Date (Revi ed 0/12/2015)