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PERMIT APPLICATION <br /> BUILDING i .MECHANICAL/ PLUMBING/SIGN /i...,RINKLER/ DEMOLITION <br /> EVERETT 32CITY OF EVERETT PERMIT SERVICES <br /> 00 CEDAR STREET,EVERETT.WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ,Blue or Black Ink Only Please) AvePROJECT SITE INFORMATION <br /> 'ROJECT SITE ADDRESS:9331 1 st A SE Everett V V a PROPERTY TAX#:004802008001 02 <br /> _EGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> )WNER NAME: Catherine D Greene TENANT BUSINESS NAME(Commercial): <br /> )WNER MAILING ADDRESS: ITIEET 9331 1 st Ave SE <br /> CITY Everett STATE wa , 98208 <br /> )WNER PHONE: 4253142928 1OWNER EMAIL:Cofq reene earthlink.net <br /> 3ONTRACTOR NAME:none <br /> :ONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> ;ONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> :ONTRACTOR LICENSE#(REQUIRED):none CITY OF EVERETT BUSINESS LICENSE#!(REQUIRED): none <br /> DRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> :ONTACTNAME: CONTACT PHONE:42531 4,2928 <br /> Cathy Greene CONTACT EMAIL:COtq reene Pa.e6-r <br /> BUILDING INFORMATION <br /> xisting Use of Building: ara a ,,1 Contract Price of Work:$1050,0Q <br /> 3roposed Use of Building:endoSed room/storage lHeat Source: []Gas ❑Electric ElOther none <br /> WILDING USE: ❑SFR 7-Townhouse ❑Duplex E-ADU [✓_Multi-Family-#Units: DCommercial ClAccessory Structure <br /> type of Project: _New _Addition '_Remodel _Repair E.T.I. C1Si n ❑Sprinkler Demolition Z✓]✓]Change of Use <br /> )ESCRIPTION OF WORK: Replace broken garage door with widow, texture& paint walls, install flooring, replace existing light fixtur <br /> %SSOC1ATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERM P ICATION <br /> Fixture Fixrum <br /> Count List of Fixtures Count List of Fixtures Crount List of Fixtures Co r o?rlre <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) S o <br /> Boiler Gas Range Clothes Washer r i ep.floor) <br /> Clothes Dryer Heat Pump ctless Dishwasher Sink- e I lft ath,bar) <br /> Duct System(Remodel) Refri tion I Drinking Fountain tility,laundry.mop <br /> Exhaust Fans(Residential) ommercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type 1) (Not HeaUAC system) Hose Bibb Urinal <br /> Exhaust Hood(Type 11) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Res ntial) Wood Stove Interceptor-Sand/ Water Service(behind meter) <br /> Forced Air Sys s I Other: Medical Gas Water Valves or Fixtures <br /> Gas Firepl llnsert/Log Roof D s Water Heater <br /> SPRI ER/SUPPRESSION SYSTEM SAIrage Ejector or Sump Pump Other: <br /> Nater Suppression System No.of Heads <br /> ;hemical Suppression SystemI 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 /> .urrent federat 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 /> 3uilding 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# <br /> 02/05/21 _F2 W -2-(0 <br /> )wner/Authorized Agent Signat&6 Date (Revised 1011012018) <br /> W2l oq- are 166 20 -6111 i�z <br />