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Feb, 10. 2017 4; 11 PM No, 4834 P. 2 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <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' PRpPERTYTAX# I ^ ^O <br /> '1l L <br /> 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> OWNER \}JaA-V— Phone/E-mail <br /> Address 1v 1�� '[� �L Clty/State/Zip \5 <br /> APPLICANT:_Owner _Owner's Agent X Contractor _Contractor's Agent 77-Senartt(must provide a letter of cow snttrom the owner to a ^+hs acy <br /> CONTRACTOR GBPS HEATING State LicA GSHEAC"930RK Ci Bus. Li 019685 <br /> Address 3409 EVERETT AVE Phone/Email 425-252-4402 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> DAWN WEIMER 425-2524402 DAWN@GSHEATIN .CON <br /> Phone/E-mall <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 of roiect; New Addition Remodel Repair T.I. Sin Sprinkler Demolition Ghan a of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERM IT.APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn -Alteration_Repair <br /> Show Number # of fixtures Show Number of fixtures <br /> A/C—air handling units Toilet <br /> Forced airs stems Bathtub <br /> Cas piping Lavatory(wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis osaf <br /> Gas rancie Dishwasher <br /> Clothes dryer Clothes washer <br /> Ran a hood Water heater <br /> Exhaust fan <br /> Sink service/bar/mo /etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boller Drinking Fountain <br /> Refficleration Floor drain <br /> Woodstove Grease trap <br /> Duciin.q 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 correct.All provisions of laws and ordinances governing this type of work will be comp, <br /> with whether specified herein or not,Tine granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That 1 am authorized by the owner of this property to perform the work for wn ch applfcatlon Is made and I comply with the State Convectors Law 113,27 ROW and 296-200A WAC. <br /> -2,11 c) <br /> Owner/Authorizsd Agent Signature Date <br /> (Revised 9/2014) <br />