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� <br />� <br />� <br />C <br />PERMIT APPLICATION <br />� <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 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 34 � 8 ROCICef@I I@r AVe PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Mafga�@t MCI20CI TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTaEET 3418 Rockefeller Ave <br />��n Everett sTATE WA Z�P 98206 <br />own,eR PHor,E: 425-359-2536 OWNER EMAIL: <br />coNTRacroR N,anne: Valentine Roofing <br />CONTRACTORADDRESS: sTREEr 910 Industry Dr. <br />a7v Tukwila sTAreWA Z,P98188 <br />CONTRACTOR PHONE: 2O6-rJ7�J-78O7 CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER T[7 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 2�6-rj52-6[��3 <br />Freddy Arreola CONTACT EMAIL: fCBdd valentineroof.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: R@SIdEIlt18I IlOt118 Contract Price of Work: $ 6833.86 <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />Building T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -# of Units: ❑Commercial ❑Industrial <br />Type of Pro'ect: ❑New ❑Addition ❑Remodel �Re air �T.I. ❑Si n ❑Sprinkler ❑Demolition OChan e of Use <br />DESCRIPTION OF WORK: <br />Replace old composition roof with new composition shingles. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn Alteration Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixtures Fixtuies <br />Toilet Backflow Preventer (tnside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: I have reviewed thrs application and confirm the information contained herein is true and correct. Work done pursuant to this permrt must comply with <br />current federal, state, and local law. The granting of a permit only authonzes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building O�cial 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 1 comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />nature <br />II/l��i � <br />Date <br />City of Everett Official Use Only <br />PERMIT,}� 1 <br />`� J � . <br />(Revised 9/23/2016J <br />