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0 PERMIT APPLICATION • <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:5124 Sea hurst Ave PROPERTY TAX#:00581 100300101 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION' <br /> OWNER NAME: BIII Blue TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5124 Seahurst Ave <br /> c,T, Everett STATE WA ZIP 98203 <br /> OWNER PHONE:425-252-0973 OWNER EMAIL: <br /> coNTRACTOR NAME WASHINGTON ENERGY SERVICES <br /> CONTRACTOR ADDRESS: STREET 3909 196TH ST SW <br /> CITY LYNNWOOD STATE WA zip 98036 <br /> CONTRACTOR PHONE: 206-378-6648 CONTRACTOR EMAIL:vstephenson@Washingtonenegy.com <br /> CONTRACTOR LICENSE#(REQUIRED):WASHIES851 NS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54773 <br /> PRIMARY CONTACT: ❑ OWNER IZICONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-378-6648 <br /> Vanessa Stephenson CONTACT EMAIL:vstephenson@washingtonenergy.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$5100 <br /> Proposed Use of Building: Heat Source: []Gas ❑Electric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Re air ❑T.l. ❑Sin ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Installing a gas fireplace. <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 Iteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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 /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink (Service/Bar/Mop/etc.) Other <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> IN 7ber of Heads <br /> ACKNOWLEDGEMENT: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 authorized 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 State Contractors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> Vanessa Stephenson oe db .­Fmpnoo PER #1 <br /> � p�_ <br /> o«2012510161400 08/25/17 D� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />