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Dec. 16. 2G16 2 ; 51FM No, 4563 F. 2 <br /> ERMIT APPLICATI00 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRIN KLERIDEMOLITI ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: d s PROPERTY Tj # PERMIT# <br /> Z 2 C1VL�vl ril l o 3- ` –`kl�-I U 1 j v <br /> LEGAL for new construction; Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ' f,�-.t Coo Phone/E-mail <br /> Address 2i3a t. r Au c, Clty/State/Zlp <br /> APPLICANT:—owner _Owner's Agent X Contractor _Contractor's Agent _Tenant(must provide s letter of ccnsrntf om the owner to do woe In the spew) <br /> CONTRACTOR G&S HEATING State Lic.# GSHEAC'°930RK City Bus. Lic.# 019685 <br /> Address 3409 EVERETT AVE khone/Email 425-252-4402 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> DAWN WEIMER 425252-4402 DAWN@GSHEATIN .CON <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t9(oo• -D <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type; _Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin S rinkler Dernalition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project. _New__gddn _Alteration_Repair <br /> Show Number # of fixtures Show Number(#)of fixtures <br /> A/C–air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> t Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boller Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I Hereby certify that I have read and examined this application and know the same to be true and carred.All provisions of laws and ordinances governing this type of work will be compi <br /> with whether specified herein or not.The granting of a perml(does not presume to give authorltyte violate or cancel the provision of Any other state or iocal law regulating construction <br /> That I am thorized by the owner of chis property to perform the work for which application is made and I comply with the State Contractors Law 18.27 ROW and 299.200A WAC. <br /> L .. <br /> Owner/Authorized Agent Signature mate (Revised 9/2014) <br />