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10177 PERMIT APPLICATIO,. <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:9024 7th Pl. W.Everett Wa. 98208 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Mary Lund TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 9024 7th PI. W. Everett Wa. 98208 <br /> CITY STATE ZIP <br /> OWNER PHONE: 425-355-3879 OWNER EMAIL: <br /> CONTRACTOR NAME:Holmstad's Plumbing Inc. <br /> CONTRACTOR ADDRESS: STREET P.O. box # 5635 <br /> C,TY Everett STATE Wa. ZIP 98206 <br /> CONTRACTOR PHONE:425-259-9131 CONTRACTOR EMAIL:holmstadsplumbing@frontier.com <br /> CONTRACTOR LICENSE#(REQUIRED):HolmSp 1 005M9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ebo26943 <br /> PRIMARY CONTACT: LI OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-9131 <br /> Terry Selfridge CONTACT EMAIL:holmstadsplumbing@frontier.com <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $ - ` ' ' . <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other New water servil <br /> BUILDING USE IZISFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ❑Commercial EAccessory Structure <br /> Type of Project: IZJNew ❑Addition ❑Remodel GRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> New water service installation/single family residence lin. domestic <br /> ASSOCIATED BUILDING PERMIT#(if applicable): D I y I 4,tgam,660, [ )�/(CATION <br /> MECHANIC 1, • ,, A• : , . 10. la <br /> Fixture kt Fixtur e <br /> Count List of Fiii) N ou a F a Cr,un . a r b-a r a tSe I f r i d``�e List of Fixtures <br /> A/C-Air Han. • 'nits .s .ing _ Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler ,_—Gas Range _ Ill <br /> }J�es� r— Sink-Commercial 3-com re floor). <br /> Clothes Dryer Heat Pump&Ductless (•fshWash�f ��r . ra Sink-Residential(kitchen bath bar) <br /> Duct System(Remodel) Refrigeration Dn Fou ain Sink-Utility, laundry, mop <br /> ill <br /> Exhaust Fans :- dential) Commercial Ventilation iihd 9 e, Toilet <br /> Exhaust Hood(T • I) (Not Heat/AC system) Hose Bibb _ Urinal <br /> Exhaust Hoo. CII) Water Heater _ i Inter <br /> sta d' Waste/Water Piping Repair <br /> Exhaust Hood -s.ential) Wood Stove Inter e d I Water Service(behind meter) <br /> Forced Air Systems Other edical Ga Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log 1•..gi I r i .11 - . •, 0 , ,ater Heater <br /> SPRINKLER PPRES. • STM 'age Ejector or Sump Pump Other new water service In <br /> Water Suppression Syste .21:11. a - ; all a ii=h o!m sta d s p <br /> Chemical Suppression Syste ' =a 1 U ax <br /> ACKNOWLEDGEMENT I - - ie • • a, ic• .n a •co • • . ation C rn�. }lotont to this permit must comply with <br /> current federal,state,and local law. The granting of a permit ont ithonzes ant`- _..I +id ritia IGky�6oh�t)I fkstbe authorized in writing from the <br /> Building Official before being authorized under any circumstanr ,am+':,,uwner,or I am authorized by the y orb,-, --.„r^,perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and""/.200A WAC. corn, C—U(' <br /> J .i'y of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent r Date: 2019.01 .14 ft(\ <br /> Date (Revised 10/10/2018) <br /> 16:06:38 -08'00' e <br />