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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/ DE j <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: 10932 PAINE FIELD WAY PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT=INFORMATION=_ ;' ' <br /> OWNER NAME:RICK/KAREN SISTEK TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2143 W 4TH ST <br /> ciTr PORT ANGELES STATE WA ZIP 98204 <br /> OWNER PHONE:360-452-7471 OWNER EMAIL: <br /> CONTRACTOR NAME: BLUE FLAME HEATING AND AIR CONDITIONING <br /> CONTRACTOR ADDRESS: STREET 7116 220TH ST sw,SUITE 1 <br /> crry MOUNTLAKE TERRACE STATE WASHINGTON ZIP 98043 <br /> CONTRACTOR PHONE: 425-771-7139 CONTRACTOR EMAIL: INFO@BLUEFLAMECOMFORT.COM <br /> CONTRACTOR LICENSE#(REQUIRED): BLUEFFH865JB CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):052790 <br /> PRIMARY CONTACT: ❑OWNER ti]CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-771-7139 <br /> NAQUIN GRAY CONTACT EMAIL: NGRAY@BLUEFLAMECOMFORT.COM <br /> wBUILDING PERMIT APPLICATION:' <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$8820.00 <br /> Proposed Use of Building: RESIDENTIAL 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 CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 2 ZONE DUCTLESS HEAT PUMP INSTALL <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> �,a <br /> MECHANICALPERMIT APPLICATION PLUMBING PERMIT APPl KATION ° <br /> Type of Project: New x Addn Alteration _Repair Type of Project: _New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units 1 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 <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/.SUPPRESSION SYSTEM <br /> Number of 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 with <br /> 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 /> Building Official be.re being authorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wit he State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM/ � .ti✓ 5/8/17 I <br /> Owner/ ' horizi,gent Sign to Date (Revised 10/12/2015) <br />