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41677- 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I I k& 69th St. SE PROPERTY TAX#: 00392000003104 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: GREG OWENS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I(S e CA tett- <br /> CITY JON/IF STATE Wer ZIP T82Ct 3 <br /> OWNER PHONE: 425-238-1463 OWNER EMAIL: gregory.p.owens@boeing.com <br /> CONTRACTOR NAME: INNOVATIVE COMFORT SYSTEMS <br /> CONTRACTOR ADDRESS: STREET 19502 56TH AVE W SUITE 101 <br /> CITY LYNNWOOD STATE WA ZIP 98036 <br /> CONTRACTOR PHONE: 425-361-2526 CONTRACTOR EMAIL: OFFICE@CALLJEFFY.COM <br /> CONTRACTOR LICENSE#(REQUIRED): INNOVCS895PM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57868 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-361-2526 <br /> RANDY REYNOLDS CONTACT EMAIL: RANDY@CALLJEFFY.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ MOD,O,r <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached ESFR-Attached 51Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (t( A- ��-� �� ��ti5�7 �j �N� L�•7 <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 #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 <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 /> 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?ranting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized der 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 comply with the Stat-Con :cto •L:w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /�I4 <br /> PERMIT V ` <br /> OwnerIAuutthorized Age t Sign. ure Date(/ 0 (Revised 9/23/2016) lJ <br />