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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 <br /> . <br /> )` ": .� �"����'#`.�t"�`E iNfQRIV��'�t�,�l..,. . ., , <br /> ��It��.e�"r Bta�k 1r�1�t� Pi�a�� � t <br /> PROJECT SITE ADDRESS:429 CC'OWiI DP PROPERTY TAX#:OOCOG�OOOOG9OO <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach cppy of long legai description) <br /> CQI�I��kCT INFQRMATIqN: " , <br /> owNeR NannE:John and Sandra Adams TeNnNr Nanne�if commer��ai>: <br /> OWNER MAILING ADDRESS: sraeer 429 Crown Dr <br /> �,n Everett STA,�WA Z�P 98203 <br /> OWNER PHONE: 42'rJ-97�-.33HJ OWNER EMAIL: sandyadams-wa@comcast.net <br /> CONTRACTOR NAME;Spencer Home Solutions LLC <br /> CONTRACTOR ADDRESS: srneeT PO box 1537 <br /> crrv Edmonds STA,�wA ziP 98020 <br /> CONTRACTOR PHONE: 425-785-8832 GONTRACTOR EMAIL:ItlfO s encerhomesolutio <br /> CONTRACTOR LICENSE#(REQUIRED): SPENCHS9OODA CITY OF EVERETT BUSINESS LICENSE#(RE IRED):O�J�ZSO <br /> PRIMARY CONTACT: ❑OWNER �)CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:4Z'rJ-7H'rJ-HH32 <br /> DaCI SpG't1CGf CONTACTEMAIL:�Jan S G't1Ce1"FlOfl'tESOIUt10tlS.GOlII <br /> ,, .; ; 8�1�:##'�i�IG:�►ER1�tT AP�'L#GA"�It�N :° <br /> Existing Use of Building: y.�� Contract Price of W rk:$ Z`J�� <br /> Proposed Use of Building: J� �2 Heat Source: �Gas <br /> Buildin Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> Type of Pro'ect: ❑New �Addition �Remodel ❑Repair . ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: ��� �l ;�� ��� �'�C� `��� � . � �� � <br /> J � <br /> ASSOCIATED BUILDING PERMIT# if a plicable: <br /> MECHANI�A�.'F�RMIT�1PPLICATIQN ; : PI.UMB(NG�ERMIT APPLICAT�QN <br /> Type of Project: _New Addn _Alteration _Repair Type of ProJect: New _Addn �Aiteration _Repair <br /> #of Lisf of Fixtmes #�f List of Fixfures #�f List of Fixtures #of List of Fixtures <br /> Fi�rtures Fixtures Fixtures Fixtures <br /> A/C-Air Handfing Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler s Lavatory(Wash Basin) Drinking Fou�tain <br /> Water Heater Refri eration 1 Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin 1 Dishwasher Roof Drains <br /> Ciothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mopietc.) Other: <br /> SPRINKLER i SUPPRF.�SSION SYSTEM ` <br /> Number ot'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 wifh <br /> current federaJ,state,and local/aw.The granting of a permit on(y authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cia/before being authorized under any,circumsfance.1 am the owner,or I am authorized by the owner of this pioperty to perform the work for which application is made, <br /> and I c /y with the State Contr c rs Law 18.27 nd 296.20 WAC. <br /> City of Everett O�cial Use Only <br /> � / � y„�� PER 1T r �r � � <br /> G«/ � \ <br /> Owner/ thoriz d Ag M Signatu Date (Revised 9/ /2016) <br />