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PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> /111W.41/Z- :::A CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blueor::BlackInk':::OnlyPIIsass) ::: PROJECT;'SITE INFORMATION .:: :..,: :::::.: ;; :. <br /> PROJECT SITE ADDRESS:5409 SOUND AVE PROPERTY TAX#:00396700201800 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . . :::': : ... . ....:CONTACT:: NF :.::•::::: ;',',: ::,.:,:.::,: ..;.:,.::.: : ,. .:.....: .. <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET5409 SOUND AVE <br /> • <br /> circ EVERETT STATE WA zip 98203 <br /> OWNER PHONE: 4258768710 OWNER EMAIL: TWARON@HOTMAIL.COM <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> crr EVERETT STATE WA zip 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: ID OWNER 0 CONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-252-4402 <br /> ALISHA CLOGSTON CONTACT EMAIL:ALISHA@GSHEATING.COM <br /> ........: : ...:,:..::::..:::;.:: ..:;r.: ::.._:"`.,:::r:......:::;.::::: :BUILDING`INFORMATION:::..:::.::::::.:...:::::.:::.:.. <br /> Existing Use of Building:RESIDENTAIL Contract Price of Work:$26327.70 <br /> Proposed Use of Building:RESIDENTAIL Heat Source: CIGas ❑]Electric ClOther <br /> BUILDING USE: CISFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ❑Commercial accessory Structure <br /> Type of Project ❑New ❑Addition RIRemodel ❑Repair ❑T.i. ESign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 5 HEAD DUCTLESS HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAiL`iPERMIT APPLICATION::::,,:::: : : : :;(PLUMBING:PERMIT.:APPLICATION' :;'.::';:: : ::::.::: <br /> Fixture „ Fixture Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—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 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 /> :::>SPRIN KLER4;SUPPRESSION;,SYSTEM``;.::i:: :: Sewage Ejector or Sump Pump Other. <br /> Water Suppression System 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,an 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 b ng authorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the St r Contractors Law 18.27 RCW and 296.2004 WAC. <br /> I v d City of Everett Official UseOnly <br /> )al) in FERMI, n V 1 1.1"01.0 <br /> Owner/Avg:al�„dl.. nt Signature Date (Revised 10/10/2018) <br />