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4277 PERMIT APPLICATION <br /> BU LDING/MECHANICAL/PLUMBING!SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P) 25-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Bluo or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2,;:,-,t 1 i^1 r%3 .;-'4(ti_;,-,,c -A-,.,4( _ PROPERTY TAX#: T, ,f{_,,;4 <br /> LEGAL for new construction: Short Plats bdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: V:.....&,./,:\A,1_1\ t $;,-rl^‘:,,+rJ$ ,y TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: si ser ,4r•' '( ) :u;,, . T r• ,A; , <br /> 1— <br /> cm( f77't i✓.i ii-k- STATE WA zip 98203 <br /> OWNER PHONE: w ; '�-(rc6- !'L1C,lt-1 OWNER EMAIL: <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: ST EET 3409 EVERETT AVE <br /> crTY EVERETT STATE WA zs' 98201 <br /> CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:INSTALL@GSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):GSHEAHC821 QR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60058 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL:DAWN@GSHEATING.COM <br /> 1 BUILDING INFORMATION <br /> Existing Use of Building:RESIDENTAI( Contract Price of Work:$ \Ol = ..,( <br /> Proposed Use of Building:RESIDENTAIL Heat Source: ❑Gas I:JElectric DOther <br /> BUILDING USE: I:ISFR ❑Townhouse EDuplex EADU ❑Mufti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project ❑New EAddition L✓^IRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixturenre Fixture Fixture <br /> Count List of Fixtures G unr List of Fixtures Count List of Fixtures Count List of Fixtures <br /> AIC-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prepfloor) <br /> Clothes Dryer ( Heat Pump&Ductless Dishwasher Sink-Residential(kitchen.bath,bar) <br /> Duct System(Remodel) I Refrigeration Drinking Fountain Sink-Utility, laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water 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 Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. <br /> Water Suppression System I I No.of Heads <br /> Chemical Suppression System 1 No.of Heads <br /> + <br /> ACKNOWLEDGEMENT.I have reviewed this pplication 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 grant(' 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 under any circumstance.t 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 State Contractors Law 1 .27 RCW and 296,200A WAC. <br /> / City of Everett Official Use Only <br /> �' I PERMIT# <br /> //-- C ' 4,61 1M °‘.OS ©CA <br /> Owner/AutI,oFiizediAgent.Signature Date ` ' (Revised 10/10/2018) <br />