5819 12TH AVE W 2021-09-02 - Laserfiche WebLink

411 III PERMIT APPLICATION �� BUILDING/MECHANICAL I PLUMBING/SiGN/SPRINKLER/DEMOLITION I' I i, - CITY OF EVERETT PERMIT SERVICES siti3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blus';or:Blaukink;OnlyPlanse)`' ::::: :„:1:!ROJECT(..'SITE I N ... .: . . ...... PROJECT SITE ADDRESS;5819 12TH AVE W PROPERTY TAX#: 00836700006200 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT:: : ;;::;.: ::,:; ;:.-.:; ... : ::::::: ::: ::::..::::;:::;,...,.. .::. :.:::. .: :: :..: .. ::: : ::,;:..:;:..::; : ;:; ::``: INFORMATION. :...:::.:.:.:::..::.:: .;::..-:...:,..,::.:.. :: : ;:::: : :::.- ::; : OWNER NAME: MICHAEL KIMBERLIN TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET5819 12TH AVE W cry EVERETT STATE WA zip 98203 OWNER PHONE: 4253080420 OWNER EMAIL:MIKE149149@GMAIL.COM CONTRACTOR NAME:GS HEATING CONTRACTOR ADDRESS: STREEr3409 EVERETT AVE crw EVERETT STATE I WA zip 98201 CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:)NSTALL GSHEATING.COM CONTRACTOR LICENSE#(REQUIRED):GSHEAHC821 QR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60058 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-252-4402 ALISHA CLOGSTON CONTACT EMAIL:ALISHA@GSHEATING.COM :::.: :::-::::-:::::•:.::::::::: s G.INFORMATION;:!:,;::;;:::.: ?:•.:::..;.::-`::;':::;:::•:::'::c;:;;'`:`::..:::;.; ::;. : ::'::::: ::.•.:.::::ii': Existing Use of Building:RESIDENTAIL Contract Price of Work:$2522.77 Proposed Use of Building:RESIDENTAiL Heat Source: OGas ❑Electric ❑Other _ BUILDING USE: CISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure Type of Project: ❑New ❑Addition ✓❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: GAS FURNACE REPLACEMENT ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICALPERMIT:AAPPLICATION`:::.?:: :.:ii 's::::;:::.;:: ..::;::•..,,:ii.::;:P :.;: _ LU MRING';PERMIT:APPLICATION;i°_::`°;°: :; ::rr;:;; ::. Fbctute futrrn Fixture Fixture Court List of Fixtures Count of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Util' ,laundry,mop Exhaust Fans(Residential) Commercial Ventilator Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) 1 Forced Air Systems Other. Medical Gas Water Valves or Fixtures Gas Fireplace/InsertLog Roof Drains Water Heater ::;::SPRINKLE Rd:SUPPRESSION:SYSTEM;::::;:.'r;;'.': Sewage Ejector or Sump Pump Other: Water Suppression System I No.of Heads Chemical Suppression System No.of Heads 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 current federal,state,and local Jpw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being ar horned under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with the State tractors Law 18.27 RCW and 296.200A WAG. CCity of Everett Official Use Only IT .--- Ala � 0 r 6 L( 2- Ownermrt %Age ignature I Date (Revised i0 • ii;