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PERMIT APPLICATIOh <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� wv�v.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: f � �� � � :�� �'�; PROPERTY TAX#: ��=i r.� � I�)C"? � 1` <br /> LEGAL for new construction: Short Plat/subdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: HOUSI►lg AUtIl01"Ity Of EV21"ett TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer3107 COlby AV2 <br /> �,n Everett STAiE�� Z�� 98201 <br /> oWNER PHONE:425-258-9222 OwtvER Emai�:Kenv@evha.org <br /> CONTRACTOR NAME Allied Construction Associates <br /> CONTRACTOR ADDRESS: srREer 3120 Hewitt Ave <br /> ��TY Everett STATE WA Z,P 98201 <br /> CONTRACTOR PHONE:425-259-6057 CONTRACTOR EMAIL:kdbjella@alliedconstruction.net <br /> CONTRACTOR LICENSE#(REQUIRED):ALLIECA008DF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O376ZZ <br /> PRIMARY CONTACT: ❑ OWNER 8 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-422-0442 <br /> Keith Bjella CONTACTEMAIL:kdbjella@alliedconstruction.net <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Multi-tenant housing Contract Price of Work: $4,000 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex BMulti-Family-#of Units:51 BCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. BSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Build a 9' long x 4' tall concrete entry sign <br /> a7�63 s�.�+. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): a�t-,(� �"'(j�-� <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 Hood Water 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 /> City of Everett Official Use Only <br /> ����_ ����.��/ PERMIT# 1 �/'�� �/�,'� <br /> G � « <br /> OwnerlAuthorized Agent Signature Date (Revised 5/20/2016) <br /> �/ � <br /> � <br /> r7— <br />