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PERMIT APPLICATIOf�L
<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. e
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<br /> PROJECT SITE ADDRESS:4610 COLBY AVE PROPERTY TAX#: T LL
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: ALEX JOHNSON/LI GOAYAN TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTaeeT 4610 COLBY AVE
<br /> arv EVERETT sTaTe WA ziP 98203
<br /> OWNER PHONE: 425-273-2936 OWNER EMAIL: AJOPTICIAN@GMAIL.COM
<br /> CONTRACTOR NAME; BLUE FLAME HEATING,AIR AND ELECTRIC
<br /> CONTRACTOR ADDRESS: srReer 7116 220TH ST SW,#1
<br /> ciTv MOUNTLAKE TERRACE sraTe WA ziP 98043
<br /> CONTRACTOR PHONE: 425-771-7139 CONTRACTOR EMAIL: INFO@BLUEFLAMECOMFORT.CO
<br /> CONTRACTOR LICENSE#(REQUIRED):BLUEFFH835MQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) �'r,�" a,
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425-771-7139
<br /> QUIN GRAY/KAItANA MONIZ CoNrACT enn,4i�: WFO@BLUEFLAMECOMFORT.COM
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<br /> Existing Use of Buildin : RESIDENTIAL Contract Price of Wo :$5575.00
<br /> Proposed Use of Building: RESIDENTIAL Heat Source: �G s ❑Ele ' ❑Other
<br /> Buildin Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> T e of Pro'ect: ❑New �IAddition ❑Remodei ❑Repair ❑T.1. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> OIL TO GAS CONVERSION FURNACE INSTALLATION
<br /> ASSOCIATED BUILDING PERMIT# if a plicable):
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<br /> Type of Project: _New Addn �Alteration _Repair Type of Project: _New Addn Alteration _Repair
<br /> #of List of Fi�ures #of Vy,�of Fixtures #°f List of Fixtures #of �/�of Fixtures
<br /> Fixtures Fi�ures Fixtures Fixtures
<br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bid )
<br /> � Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinkin Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove fGtchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hooku s Other: Clothes Washer Medical Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mo /etc. Other:
<br /> .��;��"�s��SP�ItVIK�EI�;�S,`�,P,. SS�O��I����T�F`
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correci.Work done pursuant to ihis peimit must compty with
<br /> current feder�l,state,and/ocal law.The granting of a permit oNy author¢es approved work and no deviations therefrom.Deviations musi first be authorized in writing from the
<br /> Building O�cia/before being autho�zed 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/com /y with the State Cont actors Law 18.27 RCW and 296.200A WAC.
<br /> � City of Everett Official Use On/y
<br /> PERMIT# ��� /
<br /> ,�:� ' ,�'- 7/25/17 O
<br /> O ner/A orized Agent igrlaturet� Date (Revised 10/12/2015)
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