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PERMIT APPLICATION <br /> BUILDING I IUILCHANICAL/ PLUMBING /SIGN /!P4INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 411r;e77- 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink.bnI . lease ,T4?. t Q ECT SITE,INFORMATION ,- ix i 11 <br /> PROJECT SITE ADDRESS: 6 (-).-3 lAkficl..c-Nre._ <br /> PROPERTY TAX#: c)E/g�crn nn <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> yr <br /> >.' <br /> OWNER NAME: Welk jt2 y\pft ) oIcA, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREE' /7 32( -nye SI . St <br /> CITY A)C,In fr STATE 1.14 ZIP g;72,2_, <br /> OWNER PHONE: 3Go' 7--/ 8-6,2 I OWNER EMAIL: <br /> CONTRACTOR NAME: Wolfe Plumbing <br /> CONTRACTOR ADDRESS: STREET 17321 Tye St SE #B <br /> crnv Monroe STATE WA ZIP 98272 <br /> CONTRACTOR PHONE: 360-794-8621 CONTRACTOR EMAIL: jakea@WOIfepi.COm <br /> CONTRACTOR LICENSE#(REQUIRED): WOLFEPIO33CJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED. 032640 <br /> PRIMARY CONTACT: 0 OWNER IN-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Jake Adams CONTACT PHONE: 360-794-8621 <br /> CONTACT EMAIL: jakea@wolfepi.com <br /> Existing Use of Building: Contract Price of Work:$ Z c0 <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. <br /> ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ndJ0') Udawns yQ J j1 4,1;+5 <br /> One._- y Wcfex c <br /> r L <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> wm" EOHANIOAL -� I0AD; .... � .. 711�IBIMEIfM1TP'I ' #�rCl! . U , .,_- <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn „Alteration _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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ,2 ROD !J(r t'n <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.lam the owner,or/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 /> 21 he PtIktgd2- (30 <br /> Owner/Auth :4 Ageri Signatur,41/1101' Date (Revised 5/20/2016) <br />