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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER!DEMOLITION <br /> ii CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX i_(E)everetteps@everettwagov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4200 Ridgemont Drive, Everett,WA 98203 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Bill Sheets TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4200 Rldgemont Drive <br /> Everett <br /> QITV STATE WA z1P 98203 <br /> OWNER.PHONE: 425-374-7379 OWNER EMAIL: 1 polarbearstanding@comcast.net <br /> ICONTRACTOR NAME: NW Wind &Solar S E"---1-r�,t. p <br /> CONTRACTOR ADDRESS: STREET 828 Poplar Place South <br /> I ciTv Seattle... STATE WA zip 98144 <br /> CONTRACTOR PHONE: 206-391-2003 CONTRACTOR EMAIL: consueloc@nwwindandsolar.com <br /> I CONTRACTOR LICENSE#(REQUIRED): SMEINS*066DB CITY OF EVERETT BUSINESS LICENSE#(REQUI-, D):_ <br /> 130205 <br /> i PRIMARY CONTACT: 0 OWNER Egi CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-391-2603 <br /> Dickson Harding,Project Manager consueloc nwwindandsolar.com <br /> CONTACT EMAIL: @ <br /> l BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Wor :$ 2,000.00 <br /> Proposed Use of Building: Heat Source: 1:4Gas ■ 7 to ❑Other <br /> BuildingType: ❑SFR-Detached ®SFR Attached ODuplex ❑Multi Famil -#of Units: ❑Commerciale <br /> YI? <br /> ❑Industrial <br /> Type of Project: ONew LAddition ❑Remodel El Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Installing 9.9 kW PV system on rooftop,, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of #of W #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures 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 Fireplace Wood.Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting; Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: - Clothes Washer Medical Gas y <br /> Range Hood 'Water Heater other: . <br /> Exhaust Fan _ Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> .r �,' , <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 with <br /> current federal,state, a .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 b 0lrl9Outh. 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 . With •tg'eelot IF,18.27 RCW and 296.200A WAG,; <br /> •C(tyof Everett Official Use Only <br /> P'E T# . <br /> D : •. adz;'Agent Signature Date (Revised 9/2 2016) <br />