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PERMIT APPLICATI�I
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER
<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:27 75TH ST SW PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> - COI�TACT INFOt�N1AT10N
<br /> OWNER NAME: WOJTOVEITS, BRUCE &YU CHUN TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 27 75TH ST SW
<br /> cirv EVERETT STATE WA zia 98203
<br /> OWNER PHONE:425-830-8318 OWNER EMAIL:
<br /> CONTRACTOR NAME; BLUE FL.AME HEATING,AIR&ELECTRIC
<br /> CONTRACTOR ADDRESS: sTaeer 7116 220TH ST SW,SUITE 1
<br /> crrv MOUNTLAKE TERRACE STATE WA ziP 98043
<br /> CONTRACTOR PHONE:425-771-7139 CONTRACTOR EMAIL: INFO@BLUEFLAMECOMFORT.COM
<br /> CONTRACTOR LICENSE#(REQUIRED): BLUEFFH865J6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 052790
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<br /> PRIMARY CONTACT: ❑OWNER C�CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-771-7139
<br /> NAQUIN GRAY CONTACT EMAIL: INFO@BLUEFLAMECOMFORT.COM
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<br /> Existing Use of Building:RESIDENTIAL Contract Price of Work:$ 2523.00 I
<br /> Proposed Use of Building: RESIDENTIAL Heat Source: �1Gas ❑Electric ❑Other
<br /> Building Type: I�ISFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> T e of Pro'ect: ❑New L�Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> LIKE AND KIND FURNACE CHANGE-OUT
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> ' MECHANICAL:PERIVIIT APPLICAT1aN :PLUMBING PERMIT APPGICATIQN '
<br /> Type of Project: _New � Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair
<br /> #of Ly�t of Fixtures #of u�of Fixtures #of V�of Fixtures #of /��of Flxtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A!C—Air Handlin Units Heat Pump Toilet Backflow Preventer(inside Bld )
<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 D er Hooku s Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mo /etc. Other:
<br /> �P,R.I#!�KLER;1 SUPi�R�SS�QN SY�`f`�M =,�,��
<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 comp/y 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 wrfting from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comp/y w' the State Contractors Law .27 RCW and 296.200A WAC.
<br /> Ciry of Everett Official Use Onty
<br /> F 7'p(-T'I7 PERMIT# I �D�� ��
<br /> Owner Authori Agent Signatur Date (Revised 10/ /2015)
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