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PERMIT APPLICATII''I 'I � ,l "'"'� �
<br /> BUILDING /MECHANICAL/PLUMBING /SIG�I/SPRINK R:/D y �
<br /> CITY OF EVERETT PERMIT SERVICES � �'� � ` �`�`<
<br /> 3200�EDAR STREET,EVERETf,WA 98201 f' ' �
<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: 2028 126TH PL SE PROPERTY TAX#: 0090220001800
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> owNeR NAnne: KEITH+KATHLEEN THORP TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sraeer2028 126TH PL SE
<br /> ciTv EVERETT sTnre WA zia 98208
<br /> OWNER PHONE: 425-220-5493 OWNER EMAIL:
<br /> CONTRACTOR NAME; BLUE FLAME HEATING,AIR AND ELECTRIC
<br /> CONTRACTOR ADDRESS: sTReer 7116 220TH ST SW #1
<br /> cirv MOUNTLAKE TERRACE STATE WA ziP 98043
<br /> CONTRACTOR PHONE: 425-771-7139 CONTRACTOR EMAIL:INFO@BLUEFLAMECOMFORT.COM
<br /> CONTRACTOR LICENSE#(REqUIRED): BLUEFFH35MQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (}�a�C(.0
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<br /> PRIMARY CONTACT: ❑OWNER �7 CONTRACTOR ❑OTHER(Please Specify) ;• m
<br /> CONTACT NAME: CONTACT PHONE:425-771-7139
<br /> NAQUIN GRAY/KAILANA MONIZ CONTACT EMAIL: INFO@BLUEFLAMECOMFORT.COM
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<br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ 1-0796.00
<br /> Proposed Use of Building: RESIDENTIAL Heat Source: �Gas ❑Electric ❑Other
<br /> Buildin Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industriai
<br /> T pe of Pro'ect: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> LIKE AND KIND FURNACE CHANGE-OUT AND HEAT PUMP ADD ON INSTALLATION
<br /> ASSOCIATED BUILDING PERMIT#(if a licable :
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<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair
<br /> Flxtu es ust of Fixtures Fixtures List of Fixtures #of /rst of Fixtures #°f Lfst of Fintures
<br /> 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 Firepiace 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/Mo /etc.) Other:
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<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and conect.Work done pursuant to this permit musf comp/y with
<br /> cu�rent federal,state,and/ocal law.The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must�rst be authorized in writing from the
<br /> Building Offi l before being authorize nder any circumstance.I am the owner,or I am authorized by the owner of this property to perform ihe work for which application is made,
<br /> and I com with ihe State Contracto Law 18.27 RCW and 296.200A WAC.
<br /> , Ciry of Everett Official Use Onty
<br /> PERMI��/� I �n � � I
<br /> 8/7/17 I� Y � C�
<br /> O e e Agent Si e Date (Revised 10/i2/2015)
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