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PERMIT APPLICATION <br /> BUILDING I MECHANICAL 1 PLUMBING 1 SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www,everettwa_gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1526 Lombard Ave PR°P1=RTY TAX#'00553631802300 <br /> LEGAL for new construction: Short PlaUsubdivis€ori-�-._ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Brooks Josephson TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: sTREET1526 Lombard Ave �_ <br /> CITY Everett STATE ••A ZIP 98201 <br /> OWNER PHONE:206-419-7396 OWNER EMAIL:brooks@enforthomes.com <br /> CONTRACTOR NAME;WASHINGTON ENERGY SERVICES <br /> CONTRACTOR ADDRESS: STREET 3909 196TH ST SW <br /> CITY <br /> LYNNWOOD STATE WA Zip 98036 <br /> CONTRACTOR PHONE.206-378-6927 CONTRACTOR EMAIL:eonat@Washingtonenegy.com <br /> CONTRACTOR LICENSE#(REQUIRED)':WASHIES851 NS ICITY OF EVERETT BUSINESS LICENSE 44REQUIRED): 54773 <br /> PRIMARY CONTACT: ❑OWNER t 1CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-378-6927 <br /> Ethan O n at CONTACT EMAIL:eonat@washingtonenergy,com <br /> Sulu plNE`PE>annn°APP I1CATIc i+t' <br /> Existing Use of Buildin ,11 1 Single Family Residence- Detached Contract Price of Work:$3,845.15 <br /> Proposed Use of Bull dm : Heat Source: ❑Gas ❑Electric ❑tither <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: __ ❑Commercial ❑Industrial <br /> Type of Pro"ect ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Gas furnace replacement <br /> ASSOCIATED BUILDING PERMIT#(if a icable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of <br /> #of #of List of Fixtures <br /> Fixtures Fixtures <br /> List of Fixtures List of Fixtures #of Fixtures List of Fixtures Fixtures <br /> AIC—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systerns Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavatory(Wash Basin) nkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BarlMop/etc,! Other <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Numht�r caT Heads <br /> ^CKNOWLEOGEMENT t i:ave reviewed tnis application and confirm the information contained herein is true and correct Wolk done pursuant to this peard must comply w ith <br /> current federal,state.and tical la v The granting of a permit only authorizes approved work and no deviations therefrom Deviations must first be authorized in writing fro:-n the <br /> Bfuld,nq i.Xhcia.t Ftofc bpwq aufixorixed"non=r,)vy R >'ce 1 am the owner,or I am authorized by the owner of this properly to perform the work for which appticdtron is made; <br /> J 1 .nt ay f r tw".,tit Ct,.1d datrs$. ra?S'?7 P.G€A a<t d?96 200A 4:%fi^ <br /> City of Everett Officiai use Only <br /> LPFRMIT# <br /> Owner/Authorized J. Signature Date (Rck't�eY'101;21�t1}'a W�� <br />