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? PERMIT APPLICATION <br />' /11111P*04 :1 <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> ft <br /> CITY OF EVERETT PERMIT SERVICES <br />{ 3200 CEDAR STREET,EVERETT,WA 98201 <br />} (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please). PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6520 Elliott Way PROPERTY TAX#: <br />-$ <br /> i LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> i <br /> 1l OWNER NAME: Donna Martinez TENANT NAME(If Commercial): <br /> il <br /> OWNER MAILING ADDRESS: STREET 6520 Elliott Way <br />• crry Everett STATE WA ZIP 98203 <br />! <br /> r OWNER PHONE: 4253081893 OWNER EMAIL: dbbmartinez1956t@gmail.com <br />°• i CONTRACTOR NAME: Monroe Fireplace Inc. <br /> CONTRACTOR ADDRESS: STREET 19922 State Route 2 <br /> CITY Monroe STATE WA ZIP 98272 <br /> CONTRACTOR PHONE: 360-794-8024 CONTRACTOR EMAIL: damon@monroefireplace.com <br /> li <br /> CONTRACTOR LICENSE#(REQUIRED): MONROFI85OD4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054220 <br /> PRIMARY CONTACT: IIS OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3607948024 <br /> Damon White CONTACT EMAIL: damon@monroefireplace.com <br /> I1 BUILDING;PERMIT APPLICATION <br /> 1k <br /> Existing Use of Building:Single Family Res. Contract Price of Work:$ Yra 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> • Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,-. Rtes-PcA A / b <br /> 6 4. Pip�/V4. <br /> _LNSr,� or- �qS <br /> a <br />., i <br />{i 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 /> Pj #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 't Fixtures Fixtures Fixtures Fixtures <br /> icy A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br />'I Forced Air Systems Unit Heater Bathtub Urinal <br /> i 1 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> j Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br />)_°! Gas Range Ducting Dishwasher Roof Drains <br /> 4. Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br />. I Range Hood Water Heater Other: <br /> 5: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> i' Chemical or Water I No.of Heads <br /> AI <br /> a 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 />±i 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 writing from the <br /> gtt'# Building Official before being authorized under any '-amstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> 6; and I comply with the State Contractors Law 18. RCW ani 296.200A WAC. <br /> l' City of Everett Official Use Only <br /> ki r <br />;i PERM.I # �� <br /> • <br /> \. CI-12-10 (6t' 012- <br /> .....- <br /> i Authorized Agent Signature Date (Revise 9/23/2016) <br /> ;' <br /> '( <br />