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* PERMIT APPLICATION� <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wv�nv.everettwa.gov/permits <br /> RROJECT SITE:WFORMAT��?N � <br /> PROJECT SITE ADDRESS:33�6 HOyt AVe PROPERTY TAX#:004369789�25�� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Cllafll'112C1 Wlllte TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer3316 Hoyt Ave <br /> �„Y Everett STATE WA Z,P 98201 <br /> OWNER PHONE:425-345-OZS6 OWNER EMAIL:CIIafCTIbWIIIt@@yallOO.COtII <br /> coNTRacTOR NannE:�NASHINGTON ENERGY SERVICES <br /> CONTRACTOR ADDRESS: srReer 3909 196TH ST SW <br /> �,n LYNNWOOD STATE WA Z,P 98036 <br /> CONTRACTOR PHONE:206-378-6927 CONTRACTOR EMAIL:eonat@washingtonenegy.com <br /> CONTRACTOR LICENSE#(REQUIRED):WASHIES851 NS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54773 <br /> _ .. . <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-378-6648 <br /> DeAnna Eagle CONTACTEMAIL:deagle@washingtonenergy.com <br /> ' BUILDING PERMIT APRLICATION <br /> Existin Use of Buildin :111 Single Family Residence- Detached Contract Price of Work:$3656 <br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe: ✓❑SFR-Detached ❑SFR-Attached muplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �nStBIIICIg a tanl(I@SS W8t2f I12ateC <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHA�+I;ICAL PERMIT APPLICATIQ�1 PL,UMBING PERMIT APPLIGAPION � <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn ✓ Iteratiu�n _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 Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration Shower Floor ain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Gre e Trap <br /> Gas Ran e Ductin Dishwasher f Drains <br /> Clothes D er Hooku s Other: Clothes Washer edical Gas <br /> Ran e Hood Water Heater Otflef:Tankless Water Heater <br /> Exhaust Fan Sink Service/BarlMo /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 loca!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 fhis property to pertorm 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 Offrcia!Use Only <br /> PERNJ.�T� � � � � � <br /> DeAnna Eagle a . , - - osi2�i�s � V � 0 � <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />