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I <br /> 4111/ <br /> PERMIT APPLICATION <br /> BUILDING.I MECHANICAL!PLUMBING 1 SIGN I SPRINKLER I`DEMOLITION <br /> CITY'OF EVERETT PERMIT SERVICES <br /> �` 3200 CEDAR STREET,EVERETT,WA 982137 <br /> (P)425-267 810 1 FAX 425-257-8857 I(E)everetteps{t everettwa;gav 1 wwwi.everettwa.govtpermits. <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:3706 Hoyt Ave PROPERTY TAX#: 29053000401100 <br /> LEGAL for new construction; Short Plat/subdivision; Lot No: (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Glenda Powers TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3706 Hoyt Ave' <br /> ow Everett STATE WA zip 98201 <br /> OWNER PHONE: 425-501-8987 OWNER EMAIL, <br /> CONTRACTOR NAME: Price Busters Plumbing <br /> CONTRACTOR ADDRESS: STREET 3212 NE 167th St <br /> caTv Lake Forest Park STATE WA ZS, 98155 <br /> CONTRACTOR PHONE: 206-348-88138 CONTRACTOR EMAIL: Price$UstersPlumbing @gmail.com <br /> CONTRACTOR LICENSE#(REQUIRED): PRICEBP869MA CITY OF EVERETT BUSINESS LICENSE#(REQUIRES):54602. <br /> PRIMARY CONTACT: 0 OWNER ?CONTRACTOR 0.OTHER;(P►ease Specify) <br /> CONTACT NAME:; CONTACT PHONE:206-348-81'38. <br /> Alex Borromeo CONTACT EMAIL: priceBustersPlumbinq@«email care <br /> BUILDING PERMIT.APPLICATION. : <br /> Existing Use of Building:Residential Home _ Contract Price of Work:$ 'ZS"1-n5 <br /> Proposed Use of Building; ,Meat Source: °Gas °Electric ©Other, <br /> Building Type: °SFR-Detached I:SFR-Attached ©Duplex ©M1 ufti-Family-#of Units: r °Commerrciai °Industrial <br /> Type of Project: C)New OAddition CiRernoctel ❑Repair DT.I. CISt p. I:Sprinkler °Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> � U t at Inu cvt ( (ot. u-st ( 1 s, <br /> A( a r v_` D 'Col/ - 1y -t/ -S ivaihre, cos <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project New Addn __Alteration. Repair Type of Project'_,,_,New Addn ,„Alteration _Repair <br /> Ito List of Fixtures Fixtures or Ltst of Fixtures V #of List of RitWit4 #of List of Fixtures <br /> Fanges Fltrtttfes: FtxrureS Fhrittrea <br /> 'NC-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 Fait .- Sink($ervice/Barittilapfetc,) Other. <br /> SPRINKLE t I SUPPRESSION SYSTEM <br /> Chemical or Water I [No.of Heads <br /> ACRNOWLEDGEMENr I have reviewed this application and contain the information contained herein Is true and correct Work done pursuant to this,permit must comply with <br /> current federal,state,and focal law.The granting or a permit only authorizes approved work and no deviations therefrom.Deviations must first be author in writing from the <br /> Building Ofti al before being authorized under any circumstance.lam the owner,,or am authorized by the owner of this property to perform:the work for which application is made <br /> and i:cam w the State Contractors Law 18.27 RCW and 2962004 WAC. <br /> City of Everett Ofttlal Use Only <br /> --- PERMIT# <br /> 71 //c CF.(8o-7-Opp <br /> 0 ned thorized Agent Signature Date (Revised 9/23/2016) <br />