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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� www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS:2O2 r'J9tI1 PI SE PROPERTY TAX#:00794'I OOOOrJ'rJOO
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: .JOCCIatI ACYIOt'811t0 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReeT202 59th PI SE
<br /> �,n Everett STATE WA Z,P 98203
<br /> OWNER PHONE:2O6-766-0869 OWNER EMAIL:JOC'da11aPYtOfaflt0 p�gl'Y181I.COt11
<br /> CONTRACTOR NAME;WASHINGTON ENERGY SERVICES
<br /> CONTRACTOR ADDRESS: srReeT 3909 196TH ST SW
<br /> cin LYNNWOOD STATE WA ZiP 98036
<br /> CONTRACTOR PHONE:206-378-6927 CONTRACTOR EMAIL:eonat@washingtonenegy.com
<br /> CONTRACTOR LICENSE#(REQUIRED):WASHIES85�NS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54773
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206-378-6648
<br /> �e�"'�nna Eag�e cONT,4CTennA��:deagle@washingtonenergy.com
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<br /> Existin Use of Buildin : Contract Price of W :$
<br /> Pro osed Use of Buildin : Heat Source: ❑Gas ectric ❑Other
<br /> Buildin T e: ✓❑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:
<br /> Replacing gas furnace
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
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<br /> Type of Project: New_ Addn ✓ Alteration _Repair Type of Project: _New Addn Iteration Repair
<br /> #of List of Fixtures #of List of Fixtures #�f List of Fi�ctures #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 Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Ran e Ductin Dishwasher Roof Drains
<br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other:
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<br /> ACKNOWLEDGEMENT.�!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,sfate,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 /> PERMIT#
<br /> DeAnna Eagle ����' -m��°���d•�°T�•�m� �`� osi2si�s � �� -- �
<br /> Owner/Authorized Agent SignatureA�m» Date (Revised 10/12/2015)
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