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111 • <br /> 46-77 PERMIT APPLICATION <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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1903 HOLLOWDALE PL UNIT B PROPERTY TAX#: 00537900002003 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • .CONTACT INFORMATION <br /> OWNER NAME: ELIZABETH MICHELSON TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET'1903 HOLLOW DALE PL UNIT B <br /> cm' EVERETT STATE WA ZIP 98204 <br /> OWNER PHONE: 4252394252 OWNER EMAIL:LIZ@MICHELSONLAW.COM <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: STREEr3409 EVERETT AVE <br /> cm 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 D CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-252-4402 <br /> ALISHA CLOGSTON CONTACT EMAIL:Ali SHA@GSHEATFt1 xCSQM _ ., <br /> BUILDING INFORMATION ( <br /> Existing Use of Building:RESIDENTAIL Contract Price of Work: ''. ,D jam° <br /> Proposed Use of Building:RESIDENTAIL �c <br /> P _Heat Source: ©Gas ❑Efectnc tether "' <br /> BUILDING USE: ❑SFR ❑Townhouse ©Duplex EADU ❑Multi-Family-#Units: ❑Commercial 0Accessory Structure <br /> Type of Project: ENew ❑Addition ❑✓Remodel ❑Repair ET.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: GAS FURNACE REPLACEMENT <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture 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 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 Ventilation 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/VVater 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 I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other. <br /> Water Suppression SystemI No.cf 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 befo. being authorized under any circumstance.lam 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 th ,State Contractors Law 18.27 RCW and 296.200A WAC. <br /> w4 City of Everett Official Use Only <br /> L.. -_,. q)/241/0 PE <br /> T <br /> - 0g9 . <br /> Owner/Authonietl;pgent Signature Da`fe (Reviseed'�10/10/20-8` `) <br /> if <br />