1320 HOLLOW DALE PL A 2019-03-27

PERMIT APPLICATION BUILDING/MECH..�.NICAL I PLUMING I SIG'J I� ONKLER I 'lEMOLITION r CITY OF EVERETT PERMIT SERVICES • 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (" km or `t lack Ink Only Please) 1-R©JECT SIT [Ni=t MATION PROJECT SITE ADDRESS:i' 2-0 [Ai Pc., I Z GtC✓2 PROPERTY TAX#:0 0 4 2 F6000' 0 o LEGAL for new construction: Short Plat/subdivisionFj,4,'hc-Vw pi Lot No. (attach copy of long legal description) Ns (�`E_ C.NTACT INFORMATION OWNER NAME: fir -u td/'//3 OIL TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTaEET(i')ic0/e,4v41SG%z, kw, (°;,y)-.-) 132—® 1—/,,(kot'1 Qctil. /9fcc .€- fJ CITY ,r-�11.e v_.4 • �.. STATE 4 G�cp ZIP . R 7„Lc,_ OWNER PHONE: LI.7 h • 7 Co Cj O2r? OWNER EMAIL:`1/Co/.. • \Vi t S 011 G K iAi^C ccr CONTRACTOR NAME: a. . CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION . Existing Use of Building: Contract Price of Work:$ .• Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: El Commercial ❑Industrial Type of Project: ■ 4e , ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTIO '; lift; : I°'1 c.)10—b 6kt. D v1-j�4-N;;-4.l `yam 0 2.- 002---- ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATI Type of Project: _New_ Addn _• eration _Repair Type of Project: _New Addn _Alter ' n _Repair #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Uni: Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Dis. sal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes D."er Hookups Other: Clothes Wa er Medical Gas Range •od Water H- er Other: Exhau Fan Sink service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water p No.of Heads • 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 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 Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only ' 1 .1(41 PELT LIO� er 1 uthorized Agent14341 -- 0ture Dater (Revised 9/23/2016)