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� � • � <br />PERMIT APPLICATI+�N <br />BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERM IT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />E a��REss: 3622 Rucker Avenue PRo��,�r��#1302200 PERMIT# ` <br />�IA � �,/1� � nf5 <br />EGAL for new construdion: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />Stephen Sites <br />3622 RuckerAvenue <br />PhonelE-mail <br />City/State2ip Everett, WA 98201 <br />Owner _ Owner's Agent ✓ COfitfBCtOf _ COf1Yf8CtOf�S A96nt _ T0il8flt (must pmvide a letter of consent from the owner to do work in the space) <br />NTRACTOR Gasline Mechanical, If1C. L 8� I Lic. # GASLIM1006CD COE Bus. Lic. #�3`y�7� <br />�ess PO Box 1108 woodinville, WA 98072-1108 Phone/Email 425-487-2359 <br />JANT BUSINESS NAME CONTACT FOR PERMIT <br />NA Darren Neubauer <br />Phone/E-maii dneubauer@gaslilnemechancial.com <br />BUILDING PERMIT APPLICATION <br />PRICE OF WORK � � �Q,�(� <br />Existing Use of Building SFR HEAT SOURCE: <br />Proposed Use of Building SFR Gas Electric Other <br />Building type: Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: _ New _ Addition �model Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK �eaarr;oRars,oa�e,orov�ded on tr,e aeok}: �nstall a new gas furnace and duct system with 8 supplies <br />and (1) Return. Install a new water heater, Install new renge venting system, dryer vent, bathroom exhaust <br />vent and (1) gas outlet for a range provided by others. <br />MECHANICAL PERMIT APPLICATION <br />of Project: _New_Addn i�Attera <br />Show Number (#) of fixtu�es <br />A/C — air handlin <br />/ Forced air systei <br />/ Gas pipinq <br />t�as <br />Gas <br />heater <br />rtetngeration <br />Woodstove <br />_Repair <br />units <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn _Alteration _Repair <br />Show Number /#) of fi�rtures <br />Shower <br />Kitchen sink & c <br />Dishwasher <br />Clothes washer <br />reventer <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this appfication and Imow the same to be true and correct. AI� provisions of laws and ordinances goveming this type of work will be complied <br />with whether speciFied herein or not The granting of a permit does not presume to give authoriry to violate or cancel the provision of any other state or local law regulating construdion <br />That I am autho by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br />� - � <br />Owner/Authorized Agent Signature ate (Revised 6/2012) <br />