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0 II <br /> PERMIT APPLICATION <br /> �� BUILDING I MECHANICAL I PLUMBING I SIGN i SPRINKLER I DEMOLITION <br /> *►'`f _ 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 /> (Blue or Black Ink Only Pleas.) ..... PROJECT SITE INFORMATION .... . <br /> PROJECT SITE ADDRESS:3626 ROCKEFELLER AVE PROPERTY TAX#: 00438188301900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT.INFORMATION . . <br /> OWNER NAME: JOSE HERNANDEZ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: smsm-3626 ROCKEFELLER AVE <br /> crrr EVERETT STATE WA zip 98201 <br /> OWNER PHONE: 951-751-0556 OWNER EMAIL:JEHERNANDEZ89@YAHOO.COM <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: sTREEr3409 EVERETT AVE <br /> crn 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: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-252 4402 <br /> ALISHA CLOGSTON CONTACT EMAIL:ALISHA©GSHEATING.COM <br /> . :BUILDING INFORMATION . 1 ( "�Q Qi <br /> Existing Use of Building:RESIDENTAIL Contract Price of Work:$ \` Z�3 •U 1, _ <br /> Proposed Use of Building:RESIDENTAIL Heat Source: OGas ❑Electric DOther <br /> BUILDING USE: I]SFR ❑Townhouse EDuplex ❑ADU ❑Multi-Family-#Units: ECommercial ❑Accessory Structure <br /> Type of Project ❑New ❑Addition ©Remodel ❑Repair DT.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: GAS FURANCE REPLACEMENT <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL:PERMIT:APPLICATION :::..PLUMBING PERMIT.APPLICATION:,::..:: <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count Court List of Fixtures Count List of Fixtures Count 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 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/UVater Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> I Forced Air Systems Other. Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER J. .SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. <br /> Water Suppression System I No.of Heads <br /> Chemical Suppression System No,of Heads <br /> ACKNOWLEDGEMENT:1 itava 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 I cal law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before bel g horized under any circumstance.l am the owner,or lam authorized by the owner of this properly to perform the work for which application Is made, <br /> and i comply with the St C ntractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official use Ony <br /> PERMITS rA0^ _ O� ^ p <br /> Owner/AuthO ize'd g t Signature Date (Revised 10/10/2018) <br />