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PERMIT APPLICATION <br /> 04:77BUILDING/MECHANICAL i PLUMBING 1 SIGN 1 SPRINKLER I 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.govlpermits <br /> (B1ue:or:Black:Ink.Only Pleas.)s;;::=::;::;' ::. PROJECT SITE INFORMATION . <br /> PROJECT SITE ADDRESS:2820 EVERETT AVE PROPERTY TAX#: 00593663600100 <br /> LEGAL for new construction; Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: KORY PATTISON TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTeesr2820 EVERETT AVE <br /> cry EVERETT STATE WA zip 98201 <br /> OWNER PHONE: 425-387-4003 OWNER EMAIL:KPATTiSON@LIVE.COM <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: sTREET3409 EVERETT AVE <br /> cm EVERETT STATE WA Zlp 98201 <br /> CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@GSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):GSHEAHC821 QR CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): 60058 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-610-4257 <br /> MELANIE MENDENHALL CONTACT EMAIL:MELAN I E@GSHEATING.COM <br /> ... . ......:,.. .: : .........•BUILDING:INFORMATION . ..:,..... <br /> Existing Use of Building:RESIDENTAIL Contract Price of Work:$11637.66 <br /> Proposed Use of Building:RESiDENTAIL Heat Source: OGas }]Electric ❑Other <br /> BUILDING USE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ONew DAddition ❑✓Remodel 0 Repair ET.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: HEAT PUMP+TWO INDOOR UNITS <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> •MECHANICALi•PERMIT:;APPLICATION::.::;.::::::r; ;;;; ,;;; ;;, •,;;,:..,.::.. ::PLUMBING:PERMIT:.APPLiCATION • .:.:..... <br /> Fixture Fire Fixture Fixture <br /> Count List of Fixtures count 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,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 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 WasteNVater 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 c Sewage Ejector or Sump Pump Other. <br /> Water Suppression System I No.of Heads <br /> Chemical Suppression System 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 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 being authorized under any circumstance.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> •-ii i_ai, ,L4A.� 1211 I t i 1 P ' q. 11,0010 <br /> Owner/Authth1 eXIJAgent Signature Date (Revised 10/10/2018) <br />