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101 PERMIT APPLICATION • <br />EVERETT <br />WASHINGTON <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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 I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: L j7Z O [ ' v <br />PROPERTY TAX #: 00906100000200 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: BURKETT JAMES D CREDIT SHELTER TRUST TENANT BUSINESS NAME (Commercial): COLBY DINNER <br />OWNER MAILING ADDRESS: STREET PO BOX 12550 <br />ciTv EVERETT STATE WA zip 98206 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: GS Heating & Cooling LLC <br />CONTRACTOR ADDRESS: STREET 3409 Everett Ave <br />aTY Everett STATE WA ZIP 98201 <br />CONTRACTOR PHONE: 425-610-4257 <br />CONTRACTOR EMAIL: JONATHAN@GSHEATING.COM <br />CONTRACTOR LICENSE #(REQUIRED): GSH EAHC821 QR <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 19685 <br />PRIMARY CONTACT: ❑ OWNER s❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />JONATHAN D FARRELL <br />CONTACT PHONE: 425-309-6507 <br />CONTACT EMAIL: JONATHAN@GSHEATI NG.COM <br />BUILDING INFORMATION <br />Existing Use of Building: DINNER <br />Contract Price of Work: $ 9,927.00 <br />Proposed Use of Building: DINNER <br />Heat Source: OGas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: [/ ]Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition []Remodel ❑Repair ✓❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: Installation of a duct less heat pump system for cooling dinner <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep, floor) <br />Clothes Dryer <br />1 <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />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. I 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 18.27 RCW and 296.200A WAC. <br />Signature <br />7-9-19 <br />Date <br />City of Everett Official Use Only <br />PERMIT,, <br />(Revised 10/10/2018) <br />f L <br />