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• 0 <br /> PERMIT APPLICATION <br /> 4 m <br /> BUILDING I MECHANICAL/PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 9820'1 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)eyeretteps@everettwa.gov I www,everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:3801 Hoyt Ave PROPERTY TAX M00411300300101 <br /> LEGAL for new construction: Short Plat/subdivision Lot No.. (attach copy of long legal description) <br /> ) ...,...-- <br /> CONTACT INFORMATION <br /> 4resexam*Mwernana* . , , <br /> OWNER NAME: JASON JACOBSEN TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: srREET3801 Hoyt Ave <br /> env EVERETT STATE WA zp.98201 <br /> OWNER PHONE:206-371-9720 OWNER EMAIL: <br /> CONTRACTOR NAME:WASHINGTON ENERGY SERVICES <br /> CONTRACTOR ADDRESS: srrissr3909 196TH ST SW <br /> LYNNWOOD STATE WA zip 98036 <br /> CONTRACTOR pHoNE:206-378-6613 CONTRACTOR EMAIL:HMCOORDINATORS@WASHINGTONENERGY.COM <br /> CONTRACTOR LICENSE ff(REQUIRE0):WASHIES851NS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54773 <br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 13 OTHER(Please Specify) ..... <br /> CONTACT NAME: CONTACT PHONE:206-378-6613 <br /> JO PELLETT CONTACT EMAIL:HMCOORDINATORS@WASHINGTONENERGY.COM <br /> BUILDING INFORMATION <br /> Fxisting Use of Buildinii:SINGLE FAMILY RESIDENTIAL Contract Price of Work: $3000 „,. <br /> .... , <br /> Proposed Use of Building: Heat Source: 0Gas 0Electric 00ther <br /> BUILDING USE: EISFR []Townhouse ElDupleK 12IADU 17.1Multi-Famil -if Units:_ EICommercial OAccessory Structure <br /> T pe of Pro'ect: ONow 1....JAddi ti en ERemodel ['Repair CIT.!. DSi*n OSA:inkier El Dem oliti on LChari e of Use <br /> DESCRIPTION OF WORK: LIKE FOR LIKE GAS FURNACE INSTALLATION <br /> ASSOCIATED BUILDING PERMIT# if a*olicable: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> , <br /> Fixture Fixture Fixture Fixture I <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Count Count Count Count <br /> .,. <br /> A/C-Air Handling Units Gas Piping Backflcw Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,batit,bar) <br /> - , <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation, Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove .Interceptor-Sand/Oil Water Service(behind meter) <br /> 1 Forced Air Systems - Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> -a <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Writer Suppression System -No,of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEtvIENr;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 authonzed 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 Stale Contractors Law 18.27 RCW and 296 200:4 WAG. <br /> Cii of Everett Official Use flinty <br /> — <br /> 9i I 6119 RM NC)R — IC1 <br /> Owt r uttiicrized Agent Signature Date tRevr.,,,,:I till W2018) <br />