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• <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/ 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:3020 Gedney Street I Everett WA 98201 PROPERTY TAX#: 00437672501700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Steven Hall TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET 6121 NE 175th St B402 <br /> cnv Kenmore STATE WA zip 98028 <br /> OWNER PHONE: 360-961-3638 OWNER EMAIL: reviveproperties@comcast.net <br /> CONTRACTOR NAME: n/a <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: lA OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360-961-3638 <br /> Steve Hall CONTACT EMAIL: / n. l✓t p i' i��-����i�on� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:SFR Contract Price of Worlc$30,000 <br /> Proposed Use of Building:SFR Heat Source: ❑Gas MElectric ❑Other <br /> Building Type: IMSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ®Repair ❑T.I. ❑Sign ❑Sprinkler ®Demolition ❑Change of Use <br /> DESCRIPTION OF WOR._ : _ ° ltEtaLAce-4)J�/a6a s I`DbbAg <br /> lZ-E�GAGIs' /S7'/nl4 -'aun/.1)477OA/ <br /> /If 4.--4 vL�.cy .�1• r� <br /> Re-P4 i ,Me'Pv- od6l�aa'FiA/S-/a4 A_b1> 8-4 '`l.-von4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): E 1712-010 p1712-002 /uehifrit <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project _New_ Addn Alteration ✓Repair Type of Project _New Addn Alteration _Repair <br /> F List of Fixtures List of Rxtures List of Factures Fires List of Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Hhater i Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> / Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the infonnation 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> to <br /> Owner/Authorized Agent Signature ate (Revised 9/232016) - <br />