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014 7 7 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 I www.everettwa.gov/permits <br /> ue or Black Ink Only Please) PROJECT SITE INFORMATIONn <br /> ROJECT SITE ADDRESS: it 6 I p 1�► AVE, S E b;irrvf t-9�Zo8 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: HUYEN THANH DAO TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9241 NE 173RD PL <br /> cm(BOTHELL STATE WA ZIP 98011 <br /> OWNER PHONE: 2063510285 'OWNER EMAIL: HUYEND O.CHS©GMAIL.COM <br /> CONTRACTOR NA E: N/A VL ( " <br /> LI-env" `"\ Lt, 2 -' (fid j N° <br /> CONTRACTOR ADbRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: -`, 'ACTOR EMAIL: _�+_ <br /> CONTRACTOR LICENSE#(RE(UIRED): 1�l C'j 9 J •CITY OF EVERETT BUSINESS LICENSE#(REQUIR D): . 0- �110 <br /> yy�� <br /> PRIMARY CONTACT: I21 OWNER ❑CONTRA •- = a "lease Specify) <br /> CONTACT NAME: CONTACT PHONE: 2063510285 <br /> HUYEN DAO CONTACT EMAIL:HUYENDAO.CHS aOGMAIL.COM <br /> BUILDING PERMIT APPLICATION <br /> — <br /> Existing Use of Building: Contract Price of Wo $ <br /> Proposed Use of Building: Heat Source: ❑Gas • - -- -- - • er _ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Reroofing (install new shingles) <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 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 Toilet Backflow Preventer(Inside Bldg) _ <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range _ Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range HoodWater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 /> �j�/ r CityofEverett Official Use Only <br /> Ci `( V icg/ t// B P IT l.Q\ 2 0/Lc <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />