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PERMIT APPLICATION <br /> #401:11114 <br /> BUILDING ECHANICAL I PLUMBING /SIGN /S VKLER/ 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 wwweverettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2602 Cleveland Ave Everett, WA 98201 PROPERTY TAX#: 00516859301600 <br /> LEGAL for new construction: Short Plat/subdivision MITCHELL LANDNIMP COS1ST ADD 130(593D-0° Lot Na 16,17 (attach copy of long legal descnption) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ben Smith TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4832 91st ave NE <br /> cal' Lake Stevens STATE WA ZIP 98258 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: homeowner <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: V OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-754-4612 <br /> Ben Smith CONTACT EMAIL: CUstomdesign66@Comcast.net <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ Z.0>( ) t.)C) <br /> Proposed Use of Building: Heat Source: 33;Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached YS►SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: \DO h\5 (I.\ <br /> )/ uc e 40 m s -2, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: /New _ Addn _Alteration _Repair Type of Project: ✓New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> ,-r - . A/C—Air Handling Units / Heat Pump Li Toilet D Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 0 Unit Heater i Bathtub 0 Urinal <br /> 1__ Gas Piping Q Boiler / a Lavatory(Wash Basin) O Drinking Fountain <br /> 1 Water Heater /'-�f Refrigeration N; Shower 0 Floor Drain <br /> 0 Gas Fireplace U Wood Stove ti.. Kitchen Sink&Disposal 0 Grease Trap <br /> I Gas Range - - 0 Ducting / Dishwasher 7 Roof Drains <br /> / Clothes Dryer Hookups Other: / Clothes Washer c, Medical Gas <br /> / Range Hood / Water Heater 0 Other: <br /> 0 Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' No.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 with the State Contra Law 18.27 RCW and 296.200A WAC. <br /> ^' City of Everett Official Use Only <br /> OwnerlAut rized Agen ignature Date (Revised 9/23/2016) <br />