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PERMIT APPLICATION , <br /> BUILDING/MECHANICAL/PLUMBING 1 SIGN 1 SPRINKLER/DEMOLITION <br /> "1111-74 <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)everettepsi everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink;;Only;Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:9609 BELMONT DR PROPERTY TAX#:00501000000400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT:INFORMATION <br /> OWNER NAME: DOYLE BROWN TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET9609 BELMONT DR <br /> crry EVERETT STATE WA ZIP 98208 _ <br /> OWNER PHONE: 425-355-5588 OWNER EMAIL:N.BROWN36@FRONTIER.COM <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: smear 3409 EVERETT AVE <br /> cm. EVERETT STATE WA Zw, 98201 <br /> CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:I NSTALL@GSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):GSHEAHC821 QR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60058 <br /> PRIMARY CONTACT: D OWNER CI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.2524402 <br /> ALISHA CLOGSTON CONTACT EMAIL:ALISHA@GSHEATING.COM <br /> BUILDING INFORMATION , <br /> Existing Use of Building:RESIDENTAIL Contract Price of Work:$9989.10 <br /> Proposed Use of Building:RESIDENTAIL Heat Source: ©Gas °Electric °Other <br /> BUILDING USE: IZ1SFR ❑Townhouse IDDuplex DADU DMulti-Family-#Units: °Commercial DAccessory Structure <br /> Type of Project: ONew DAddition [)Remodel ❑Repair DT.I. ©Sign [)Sprinkler ©Demolition °Change of Use <br /> DESCRIPTION OF WORK: DUCTLESS HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if a plicable): <br /> MECHANICAL PERMIT APPLICATION ...., PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Factures countList of Fixtures Count List of Fixtures Court List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer i Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry mop <br /> Exhaust Fans(Residential) Commercial Ventilator Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease _ WastelWater Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems __ Other: Medical Gas Water Valves or Fbdures <br /> Gas Fireplace/Insert/Log - W Roof Drains Water Heater <br /> SPRINKLER 1.:SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I 'No.of Heads <br /> ACKNOWLEDGEMENT:i eve 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;;.cal 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 before bel g authorized under any circumstance.I am the owner,or Jam authorized by the owner of this property to perform the work for which application is made. <br /> and I comply with the St= r Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �/ Q PER IT# <br /> ���� �� ori �(o�, <br /> Owner/Authprzeii A ent Signature Date (nevi 1(1/1 018) <br />