10713 10TH DR SE 2019-07-09 - Laserfiche WebLink

INN PERMIT APPLICATION 112 BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION E V E R E T TCrrY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (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:1071310th Dr Se, Everett WA 98208 PROPERTY TAX#:00762500003900 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Dyan and Bryce Shepherd TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 10713 10th Dr Se cry Everett STATE WA zip 98208 OWNER PHONE: 425-951-0633 OWNER EMAIL:dyan.n.shepherd@bannerbank.com CONTRACTOR NAME:Powers Chimney& Masonry CONTRACTOR ADDRESS: sTREET5205 170th Place NE cry Arlington STATE WA ZIP 98223 CONTRACTOR PHONE:360-691-9828 CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED):POWERCM9O4PQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 053258 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-951-0633 Dyan Shepherd CONTACT EMAIL:dyan.n.shepherd©bannerbank.com BUILDING INFORMATION Existing Use of Building:Residence Contract Price of Work:$1310.40 -.. Proposed Use of Building:Residence Heat Source: ❑Gas (Electric OOther Wood Stove BUILDING USE: OSFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ONew ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Install Wood Stove in home for alternate source of heat. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Ciounr List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) 1 Wood Stove Interceptor-Sand/oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System I No.of Heads ACKNOWLEDGEMENT.:I have reviewed this application and confirm the information contained herein is true and coned.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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I-.mp %h the State Contractors Law 18.27RCWand 296.200A WAC. City of Everett Official Use Only (C� I :.-.i�� ) 512_�,1 1 PERMITMi o D\0 • • �-7.\— h h. c ^'Agent Signature Date (Revised 4110/12018) 1