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• PERMIT APPLICATION • <br /> ill <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (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:2602 HOYT AVE EVERETT WA98201 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: LIVING FAITH TABERNACLE TENANT BUSINESS NAME(Commercial): DON JACOBSEN <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: 425-404-1918 OWNER EMAIL: <br /> CONTRACTOR NAME:3-D ROOF SYSTEMS <br /> CONTRACTOR ADDRESS: STREET PO BOX 330 <br /> CIn, LYNNWOOD STATE WA ZIP 98046 <br /> CONTRACTOR PHONE:425-775-0232 CONTRACTOR EMAIL:3-DROOFSYSTEMS.COM �7 <br /> CONTRACTOR LICENSE#(REQUIRED):3DROOSL982CJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):. /Jq ?, <br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-231-7468 <br /> JAMES CARROLL CONTACT EMAIL:JIM@3-DROOFSYSTEMS.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building: ��� Contract Price of Work:$75,584.49 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: _ ❑✓Commercial ['Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: REMOVE COMPOSITION SHINGLES. INSTALL 1/2 CDX PLYWOOD OVER CAR DECKING <br /> INSTALL MALARKEY SECURE START UNDERLAYMENT. INSTALL MALARKEY VISTA AR <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) , Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer _ Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher _Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease - Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log REROOF Roof Drains Water Heater <br /> SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 Contractors Law 18.27 RCW and 296 200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT ID���,' o <br /> y-yl <br /> JAMES CARROLL °: N acre -a'''''s"---.--- 9/17 20 v <br /> nro a.. <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />