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�lul, 21, 2U16 8,42AM <br />N�, 3�57 P, 3 <br />PEI�IIl1IT APPLICATION <br />BU�LbING/MECHANICAL/PLU�IIIBING/SIGN/SPRINKLER/DEMOLIT�ON <br />CITY OF EVERETT PERNiIT SERVICES <br />3200 Cedar St., �verett, WA 9�20� 425-257-8810 FAX �25-257-$857 www.everettwa.org <br />SITE ADDRESS: <br />RTY TAX d <br /># <br />LEGAL for new construction; Short Pl�t/subdivision Lol No. (anach copy of lonfl lec�al descripfion) <br />OWN�R `�� l � �u � Phone/E�maif =Z "] ' <br />� <br />Address CilylSl6l0rzip � <br />APPLICAN7: _ Owiier _ Owner's Agent %� Contractor _ Gonlractor'8 Agenf ,,�,,,, Ten9n� (mus�provicie a IeueroPconsencirom ine ownerw �o work In lhe e�s <br />C�NTRACTOR G&S HEATING state �ic. # GSHEAC�'930RK Cit Bus. Lic. # 019G85 <br />idress 3409 EVERETT AVE PhonelEmall 425-252�4402 <br />ENAN7 BUSINESS NAME coNTAC7 FOR PERMIT <br />BUILDING PER.MIT APPLICQTION <br />bAWN WEIMER 425�252-4402 DAWN@GSNEATIN .CO1� <br />Phone/E-mail <br />GONTRACT PF210E O� WORK � W� o CJV <br />Existi��g Use oF Building � <br />Proposed Use of I�uildiny <br />Bu;lding type: _ Sfngle Farnily _ Duplex _Townhouse _ Multi-Family _ Gommercial <br />Type of_project: New Additlon Remodel Repair T,I, Slqn Sprinkle <br />DESCR]PTION OF WORK (additional space provided on the bsck): <br />��� ��� ��� <br />MECHQNIC�L PERMIT APPLICATION <br />Type ot f'roJect: JNaw _Adcin _Alteratlon __,_Repair <br />Show Numf�or # of flxiuras <br />A/C — a[r handlir�� uni(s <br />Forced air sVstems <br />Water heater <br />Gas fireplace <br />Gas range_ _ <br />Clothes dryer <br />Range hood <br />ExhaUst fan <br />1�8ter <br />r <br />Woodstove <br />SPRI�IKLER / SUPPRESSION SY�TEM <br />Numher of Heads <br />HEAT SOURC�; <br />Eleclric � Ott��r <br />Cll�h9e of Use <br />pLr11VI�IC�G �E1211f11T APPLICATION <br />Of Project: �New�4ddn _Arierat�on _RePeir <br />Show Number(t�) af flxtures <br />I Toilet <br />Shower <br />Kitchen sink 8� <br />Dishwasher <br />Clothes washe <br />Water lieater <br />Slnk (servicelF <br />Backffow prevF <br />Urinsl <br />Drinkinq Fount <br />�loor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Ofher: <br />Olher: <br />basin <br />I hcY�Uy cQniry �ttsL I have read snd examinad thie epplicaiion and know lho samo to bo Irua and corrccl. All provi5ions pf faws and otdinanccs govorning lhi� lypo of work will bo comp' <br />wlLh wneLher specifiod haroin or Ytol. The qranlinfl oP a perm�l does nq( preeume to g(ve sutqorl�y �o vlolsla or cancel the provlslon of si�y olher elaLe or loca� I�w reyu��lln8 �nslrucllon <br />That I am dulll�Yzed uy llle owner of Ihis property lo perform ihe work for which spplicalion is made and I comply wilh lho Slale Conlreclors Law 16.27 RCW and 2fl6200A WAG. <br />/// ; -,(� <br />ownarlAuthorl 'd �ent Slgnature Date (Revlsed 9/2p14) <br />