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• PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SP INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4M7T 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 l (E)everetteps@everettwa.gov l www,everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:6525 Willow Rd PROPERTY TAX#:00371400001501 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Shannon ZlvkOvich TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s.REET6525 Willow Rd <br /> c,N Everett STATE WA ZP 98203 <br /> OWNER PHONE:425-231-5626 OWNER EMAIL: <br /> CONTRACTOR NAME:WASHINGTON ENERGY SERVICES <br /> CONTRACTOR ADDRESS: STREET 3909 196TH ST SW <br /> CITY LYNNWOOD STATE WA ZIP 98 <br /> CONTRACTOR PHONE:206-378-6648 CONTRACTOR EMAIL:deagle@washingtonenegy.com / <br /> CONTRACTOR LICENSE#(REQUIRED):WASH IES851 NS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54773 <br /> PRIMARY CONTACT: ❑ OWNER 71 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-378-6648 <br /> DeAn na Eagle CONTACT EMAIL:Beagle@washingtonenergy.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $3000 <br /> Proposed Use of Building: Heat Source: ❑Gas []Electric []Other <br /> Building Type: QSFR-Detached ❑SFR-Attached muplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Pro ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I ❑Sin []Sprinkler []Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Replacing gas water heater <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn DAteration _Repair Type of Project: _New _Addn JDAteration _Repair <br /> #of #of #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of 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 lGrease 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/Bar/Mop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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./am the owner,or I am authorized by the owner of this property to perform the work for which application is made. <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> Ethan Onat - -^ 02/28/17 PEf �� <br /> Owner/Authorized Agent Signature p Date (Revised 10/12/2015) <br />