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PERMIT APPLICATiON
<br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,FVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.evereitwa.govlpermits
<br /> P12Q.3�C7`�NTE l�+t�'��i14�A.`�'��fa1
<br /> PRCIJECT SITE AQDRESS:�93� RUCk@r AV@ PROPERTY TAX#:Q04370377��5��
<br /> LEGAL for new construction: Short PI�Usubdivision_____„_.__ __Lot No, (attach copy of long legal descriptionj
<br /> �.�����`r� ������,���`��� '��. .. ..
<br /> OWNER NAME: AIaCI T@tCaUlt TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sraeeT1931 Rucker Ave
<br /> ��N Everett Gz�jE WA _,�F_ 98201
<br /> ow�vER P�oNe:425-345-5608 owNER EMAi�:boxmanalan@gmail.com
<br /> CONTRACTOR NAME WASHINGTON ENERGY SERVICES
<br /> CON7RACTOR ADDRESS: srReeT 3909 196TH ST SW
<br /> cirr LYN N WOO D STATE WA ziP 98036
<br /> �oNTRacTOR PHONE:206-378-6648 cotirRncTOR em,ai�:deagle@washingtonenegy.com
<br /> CCTNTRAC70R LICENSE#{REQUIRED):WASHIESSS'I NS GITV OF EVERETF BUSINESS LICENSE�!{It�t�ltfF2�T3}. 54773
<br /> _ _
<br /> �'RIMARY CONTACT: ❑OWNER �C{)NTRACTOR ❑OTHER(Please Specify}
<br /> CONTACT NAME: CONTACT PHaNE:206-378-6648
<br /> QeAnna Eagle CONTACTEMAIL:deagle@washingtonenergy.com
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<br /> Existir3� Use of Bwit3inr�. i� ,„�� 41 j,, ~ � �� �' , . tract Price of W�rk:$ �
<br /> F'rnpns�d Use of Buildiny� Heat Source: ❑Gas ❑Electric ❑t}th�r
<br /> Buildin Type: �SFR-Detached ❑SFR-Attached �uplex ❑MuNi-Famil -#of Units: ❑Commercial ❑Industrial
<br /> T� e of F'toject: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Si�n I�Sprinkler ❑Demolition ❑Ch�n��of Use
<br /> �����1PT1°�°F�°�°�: Installing gas fireplace insert and replacing gas water heater
<br /> .ASSQCIATED BUILDING PERMIT#{if a�plical�l�y:
<br /> ��+�M�+��t#�AL P�RME'T Al�F"�,I��t1"M"MC�N�N ii,, �''�.M.��IIBtMV� �"��M�11"�"�P��r��"�`1�IV
<br /> 'fype�of Project: _New _ Addn ✓ Alteratfon _Repair 7ype of Project: _New _Addn Iteration _Repair
<br /> #of List of Fixtures #of List of Flxtures #of list of Fixtures #of List oi Fixtures �
<br /> Fixtures Fixtures FlxWres Fixtures
<br /> ,�dC,:' Air M�r�rilinq Un'rE� Heat Pump Toilet Backfifow Preventer(Inside Bidg)
<br /> F�src�d�ir�yskems Unit Heater Bathtub Urinal
<br /> Gas Pi inq Boiler Lavatory(Wash Basin} Drinkin Fountain
<br /> � Water Heater Refrigeration Shower Flaor Drain
<br /> � C;�s F'�r�}�t�c� Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hoakups Other. Clothes Washer Medica!Gas
<br /> Ran�e Hood Water Heater Other.
<br /> ��m..n..__
<br /> Exhaust Fen Sink(Service/BarlMop/eta) Other:
<br /> 3PRIP,�i�L»�Ft t SUPP�����if#N SYS7'�M
<br /> �..._.._.. ...�. �
<br /> Number of Heads
<br /> ,,,,flt[.��E'u�Gc�fi>�N�r t na✓z,�r.�_KHC_-.i;a};�:l����iur ��ct,:.�niirm�Y.: �n�i�r.r,afion ccrtf_�trec7 ho�er,7;s trrfe a�tel ccrre�t Jlcrk dor.e perrsu�r�t ro N�rs parr;iit�r�::sf c��r*��,y,n�Pr:
<br /> r,u�m+1 fede a1.5��(G.ar�a;�r.�a�t�r✓.< 7 hE�qran�rr,y ofa permit only auth,��rz3s.approved ta-orH antl no devra!ict s'hr;r2f�o^,i.J.,�id�`�,�s n�ist f�rsi bP 2iitt�vn�ed r .,.:t,ng .'�-n tr;
<br /> E3urfdu.q C�rfi:.i�i;;,t;,i;hr,.��r,a,�...;oriz��;ilnder any crrciunstance %um tt,e own��:r,c�i om ai�Phanzed n,�t'*o;���.•�rer ot�h;s il�apr.�y f�r�e�crm;he i� : c�v,l:J� �r},uc,ati,;=ic,na,-re
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<br /> {;�ty i ,_varn> >rrr.-'�a:ii e n:y
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<br /> �e�rfz�� F��;e '= �oi�il�s
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<br /> C)ws�c�rlAutt�orized AgenE Sigr73ttrco_ ��_i3atn�� t �vrSF,_r - �'1.��J1.j
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