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PERMIT APPLICATION <br /> #11111j:g BUILDING / MECHANICAL/ PLUMBING 1 SIGN 1 SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT',WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8957 1(E)everettepseeverettwa.gov I vmw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2105 Grand Ave PROPERTY TAX#: 00437443200200 <br /> LEGAL for new construction: Short P1atisubdivvsion 432 D-00-S Lot No.',"-' (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Johan Valentin TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO Box 52641 <br /> c.--, Bellevue STAT,' WA ZtP 98015 <br /> OWNER PHONE: 2142280536 OWNER EMAIL: johan.valentin@gmail.cam <br /> CONTRACTOR NAME: Owner <br /> CONTRACTOR ADDRESS: STREET See above <br /> CITY See above sT,ATe ZR <br /> CONTRACTOR PHONE: See above CONTRACTOR EMAIL: See above <br /> CONTRACTOR LICENSE#(REOUIRED): N/A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):N/A <br /> PRIMARY CONTACT: ([l OWNER ❑ CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2142280536 <br /> Johan Valentin CONTACT EMAIL:johan.valentin@gmail.com <br /> BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building Vacant Contract Price of Work:0200 <br /> Proposed Use of Building SFR Heat Source (Z1Gas DElectric ❑Other <br /> Building Type 0SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Farnily-#of Units: ❑Commercial ❑Industrial <br /> Type of Project. ❑New DAddition ❑Remodel ORepair ❑T.I. ❑Sign DSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Repair Roof leaks <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Now _ Addn _AlterationRopair 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 /> AIC—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:t 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 federer,state,and Local law. The granting of a permit only authonzes approved work and no deviations therefrom.Deviations must firs!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 properly to perform the work for which application is made, <br /> and I comply will; State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> " �—= PERMIT" <br /> ..4. <br /> ,. <br /> ,,,7,,,,---- <br /> Owndf-/Authorized Agent Signature Date (Revised 9 3)2 16) <br />