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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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT'SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3228 Norton Ave 14 4 PROPERTY TAX#: 00437577201902 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Housing Hope TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5830 Evergreen Way <br /> cnTY Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425-347-6556 OWNER EMAIL: toddbullock@housinghope.org <br /> CONTRACTOR NAME: To Be Determined ektliartjeAn <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 01-44 I(j#6 <br /> PRIMARY CONTACT: ID OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Todd Bullock CONTACT PHONE: 425-347-6556 <br /> CONTACT EMAIL: toddbullock@housinghope.org <br /> BUILDING'PERMIT APPLICATION <br /> Building: Multi-family Contract <br /> ExistingUse of Price of Work:$ qv A,L.vv. <br /> Proposed Use of Building: Multi-family Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ®Multi-Family-#of Units: 4 El Commercial ❑Industrial <br /> Type of Project: El New ❑Addition MRemodel El Repair INT.!. ❑Sign ❑Sprinkler ®Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> front duplex:kitchen remodels,add range hoods,replace tubs and lavatories in bathroom,replace siding,remove upper deck,re-roof <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn X Alteration _Repair Type of Project: _New _Addn X 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 I Unit Heater Ar2. Bathtub Urinal <br /> Gas Piping Boiler ) Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove /k'I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Al Ducting or t Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> ILA' Range Hood i1- Water Heater Other: <br /> Zvi' Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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 /> RCA//1/ <br /> / / City of Everett{O�fficial Use Only <br /> �L�' i i 406%a QIP PERMI£ U01- <br /> (/® � i <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016)` <br />