Laserfiche WebLink
arr 0 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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION '1''n.) <br /> PROJECT SITE ADDRESS: ��1f'D tr 5Sh Ave hetw6PROPERTY TAX#: 00500302700200 <br /> LEGAL for new construction: Short Plat/subdivision blk 27 twn of Lowell Lot No.2 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Elm Homes LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5629 151st PI SW <br /> CITY Edmonds STATE Wash. ZAP 98206 <br /> OWNER PHONE: 425 350-0951 OWNER EMAIL: elmhomes@comcast.net <br /> CONTRACTOR NAME r k,' 1 H 004Es i.AC <br /> CONTRACTOR ADDRESS: STREET 5629 151 st PL SW <br /> CITY Edmonds STATE Wa. ZIP 98206 <br /> CONTRACTOR PHONE: 425 359-0951 CONTRACTOR EMAIL: elmhomes@comcast.net , <- <br /> CONTRACTOR LICENSE#(REQUIRED):V`/'' MI b Z. Q 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIR D): Sg(Q09 <br /> PRIMARY CONTACT: IR OWNER ❑ CONTRACTOR OTHER(Please Specify) Ron Allen <br /> CONTACT NAME: CONTACT PHONE: 425 508-4380 <br /> Ronald C. Allen 425 508-4380 CONTACT EMAIL: ronallen3431Ayahoo.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Single Family Residential Heat Source: 0Gas Electric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> New 1943 Mid-Entry Home on vacant lot <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: /New _ Addn _Alteration _Repair Type of Project: Xa New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> r Forced Air Systems Unit Heater i Bathtub Urinal <br /> Y Gas Piping Boiler = Lavatory(Wash Basin) Drinking Fountain <br /> t Water Heater Refrigeration �1j` hower Floor Drain <br /> ( Gas Fireplace Wood Stove [ /Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> ( Clothes Dryer Hookups Other: ( Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 4 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 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 he State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ' City of Everett Official <br /> Use <br /> rOnly <br /> 4k_ 1., / 1 , I q PER( IT.( oO., , 0( 5 <br /> Owner/Authorized Agent Signatur Date (Revised 9/23/2016) \ <br /> (72.../. <br />