12622 20TH DR SE 2019-11-15 - Laserfiche WebLink

PERMIT APPLICATION BUILDING I MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: �f i" L �^ �� PROPERTY TAX#: LEGAL for new construction: Shot Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: \CLArNX IA ' l'"$ TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 1 'lam ✓ 24S d�- f2 S\.-r, ciT( STATE WA zip 98203 OWNER PHONE: OWNER EMAiL: CONTRACTOR NAME:GS HEATING CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE cm EVERETT STATE WA Zw 98201 CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:INSTALL@GSHEATING.COM CONTRACTOR LICENSE#(REQUIRED):GSHEAHC821 QR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60058 PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 DAWN WEIMER CONTACT EMAIL:DAWN@GSHEATING.COM BUILDING INFORMATION Existing Use of Building:RESIDENTAIL Contract Price of Work:$2000 Proposed Use of Building:RESiDENTAiL Heat Source: i:Gas ❑Electric ❑Other BUILDING USE: ❑SFR ETownhouse ❑Duplex EADU ❑Multi-Family-#Units: ❑Commercial EAccessory Structure Type of Project: ❑New ❑Addition ✓❑Remodel ❑Repair ❑T.]. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: REPLACE GAS FURANCE ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures coin List of Fixtures Count List of Fixtures Count List of Fixtures A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior\ Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems _ Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER!;SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. Water Suppression System No.of Heads Chemical Suppression.System No.of Heads 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 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 Building Official before being authorized under any circumstance.I em the owner,or/am authorized by the owner of this property to perform the work for which application is made, and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PER #�R03_on � DAWN WEIMER Pala 2 tlOnal Ey On WH-08,00 'Pab',2019.0208 X200:59-09V0 OwnerlAuthbeEAgentSignature Date (Revised 10/10/2018)