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O�t. 7, 2016 12 , �3PM � � No. 395b P. 2 <br /> ' PERMIT APPL�CATION <br /> BUIL.D�NG/MECMANICAL/PL�IIIiBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 Cedar St., Everett, WA 9820� 425-257-8810 FAX 425-257-8857 www.Everettwa.org <br /> 51TE ADDR�SS: PR�p�RTYTAX t# I # <br /> C�Uk�I��Uo�o �30� � � � ��- <br /> LEGAL for new construction: Short plat/subdivisivn Lot No, (attach copy of�ong legal tlascription) <br /> OWNER ��(,�Q,�—�" Phone/E-mai� `L5�-7,:5 r �Zp <br /> Address City/State/Zip �y�- �� `{ 3 <br /> APF'LICANT:_Owner _Cwner's Agent X COnttdGtor �Contractors Agent _Tenant�musi vrovlae a ietter of cv�s�ncrrom�h=o�ner io do work in ene apeca� <br /> CONTRACTOR G&S HEATING state�ic.# GSHEAC*930RK Cit Bus. Lic.# 019635 <br /> ,4ddress 3409 EVER�T7 AVE Pnone��maii 425-252-4402 <br /> TENANT BUSINESS NAME CONTACT FOR p�RMIT <br /> DAWN WEIMER 425-252-4402 DAWN@GSHEATIN _CO1� <br /> Phone/E-mail <br /> BUILDING PERIVIIT APPLICAT[ON CON7RACT PR10E OF WORK �7U0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use af 6uilding �as Electrlc Other <br /> Building type; _Single F�mily _Duplex_Townhouse _Mu(ti-Family �Gommerciaf <br /> T e of ro ect: New Addition ftemodel Re air T,I. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(adGifio�,el spaca provided on the back); <br /> '(�lace. � �e�-- <br /> MECHA�I�C�1L PERMIT APPLICATION PLUMBING p�RMIT APPL[CAT�ON <br /> Type of Project: _New_Addn �Alteration_Repair Typs of ProJsct: ,New�Addn _Alteration_Rapair <br /> Show/Jumbar of f/xfures Show Number #)of fixtures <br /> A/C—alr handlin units Toilet <br /> For�ed air svstems Bathtub <br /> Gas i inq Lavato wash basin <br /> Water heater Shower <br /> Gas frre lace Kifchen sink�dis osa.l <br /> Gas ran e Dishwasher <br /> Clothes d er �lothes washer <br /> Ran e hood Water heater <br /> Exhaust fan 5ink service/bar/mo /etc. <br /> Heet um 6ackflow reven#er <br /> Unit heater Urinal <br /> Boller Drinkin Fountain <br /> Refri eration Floor drain <br /> WoodstoVe Grease tra <br /> DUctinq Roof drains <br /> Other Medical Gas <br /> SPRINKLER!SUPPR�SSION SYSTEM Other: <br /> Number of Heads Other: <br /> I Itereby�rtlfy that I have read end examinCtl t111s appUCatlon snd know the same to ba true and corroCt.All pfOvISVO�S o�laws snd ordlnancae governing this type of work will bo compl <br /> with whelher spac�etl hereln or not.The granting of a permit does not prosume to g1v0 authorqy co vlolate or cencel the provision of any othcr Etate or IOCa�law regulating construction <br /> TI1at I 2m$ hodzed by the owner of this propefty to pe�fOrm ttte work tor whlch applicstion is meda and I comAly With the Stale Contractors Lsw 18.27 RCW end 286.200A WP,C. <br /> �o '� 1b <br /> Owner/Authon gent Signaturs Date (Revlsed 9/2014) <br />