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Dec, 29, 2016 9 ; 08AM No, 4626 P. 2 <br /> 1 ERMIT APPLICATIO, . <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS' ' PROPERTYTAX if <br /> LEGAL for new construction, Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/state/zip LAAiLLr <br /> APPLICANT:—owner _Owner's Agent X Contractor J Contractor's Agent _Tenant(musk provide a letter of consentliorr the owner to do wont In the apace) <br /> CONTRACTOR G&S HEATING State Lic.# GSHEACs'930RK City Bus. Lir,,# 019685 <br /> Address 3409 EVERETT AVE Phone/Email 425-252-4402 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> DAWN WEIMER 425-252-4402 DAWN@GSHEATIN .CON <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_'lyl�f)L7.f�71 <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 roject: New Addition Remodel Repair T.1. Sign Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(addlrlonal space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project: _New_Addn Iteration_Repair Typo of Project: _Now_ _.Alteration Alteration_Repair <br /> Show Numbor # 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/mo /etc. <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler 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 certfFy that I have read and examined this application and Know the same to be true and correct.All provisions of laws and ordinanccs governing this type of work will be compi <br /> with whether specified herein or not,The 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 /> Tnat l am authorl by the owner of this property to perform the worK Tor wrtich application Is made and I comply with the State Contractors Law 18.27 RCW and 296.2QQA wAC, <br /> 114 1 <br /> Own er/q horiz signature die (Revised 9/2094) <br />