9507 18TH AVE W 2019-06-05 - Laserfiche WebLink

• Qrx.77. 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 9507 18th Ave . W. PROPERTY TAX#: 00947000000200 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Paul Nguyen TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 9507 18th Ave . W. c,T' Everett STATE WA ZIP 98204 OWNER PHONE: 425-404-0200 OWNER EMAIL: Yvanpa12002@yahoo.com CONTRACTOR NAME: Eric Gagon - Kustom US CONTRACTOR ADDRESS: STREET 7733 W. Bostian Rd. , Suite 1-B ciT' Woodinville STATE WA ZIP 98072 CONTRACTOR PHONE: 425-892-1901 CONTRACTOR EMAIL: eriC CONTRACTOR LICENSE#(REQUIRED): KUS TOUT 8 4 7NQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 056203 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ®OTHER(Please Specify) Agent CONTACT NAME: CONTACT PHONE: 206-281-7500 Chris Bacus-Pacific Engineering Tech. CONTACT EMAIL: cbacus@pacengtech. com BUILDING PERMIT APPLICATION Existing Use of Building: Single Family Residence Contract Price of Work:$ 50 , 000 Proposed Use of Building: Heat Source: ®Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ®SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial Type of Project: ONew ❑Addition ❑Remodel ®Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: (See Attached) ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER I SUPPRESSION SYSTEM Chemical or Water 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. I am the owner,or I 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT#-- ^ f 4/25/17 tC� 003 Owner/Authorized Agent Signature Date (Revised 9/23/2016)