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I 4 PERMIT APPLICATIONS <br /> gr BUILDING I MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)everetteps@everettwa.gov J www.everettwa.gov/penn'rts <br /> (BlueorAladkAnki,Ohly'Please)':::,1::. :;r:;'::;;;;sPRODISCT.'SITE::INFORMATIONc ;::; .:::.::.:::.: :*;::i.,, -••....::.:: ::•. <br /> PROJECT SITE ADDRESS:`CIO ti.x�rct A Q �� ,PROPERTY TAX#: tr ?� <br /> LEGAL for new construction: Short Piat/subldivlsion Lot No. (attach copy of long legal description) <br /> .,. .. . . .. . .. .... ... . . ... .... ... ..!2C T:iN�'ORMATION . .. <br /> OWNER NAME: 1 rt,t,..te" TENANT NAME{If Commercial): <br /> 3 it <br /> OWNER MAILING ADDRESS: STREET (9 \ Vv ic- z� <br /> CITY 7 o STATE £1 A7 zi E62.C..1 <br /> OWNER PHONE: U5 7 ---u_ (,.F OWNER EMAIL: <br /> CONTRACTOR NAME; G&S HEATING t• <br /> CONTRACTOR ADDRESS: sresrr 3409 EVERETT AVE <br /> crrY EVERETT STATE WA <br /> ZIP 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@gSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED): GSHEAC*939RK CITY OF EVERETT BUSINESS LICENSE it(REQUIRED): 019985 <br /> .PRIMARY CONTACT: 0 OWNER ICONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> ..:.....::::.. :.:.....: ..„...::: :;...•:::•::.:�::::A: UI6 <br /> . ...:•:.:�:..,........ ...... .. ..._...:::::::: •....::•.::::�.B NAIL PE P <br /> . .. . .. . ..... .. .. .. ... .. .. .. .... . ='D RMIT�A PLICATION� ": ;:;:. <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ -11 <br /> Proposed Use of Building: RESIDENTIAL Heat Source: IIGas ❑Electric ❑Other <br /> Building Type: MSFR-Detached EISFR-Attached ODuplex OM0i-Family4 of Units: El Commercial ❑Industrial - <br /> Type of Project ONew ❑Addition ❑Remodel ❑Repair 0T.1. OSign COSprinkler El Demolition CI Change of Use <br /> DESCRIPTION OF WORK: .0 <br /> - , C.e. Watt 'fitr. 'AA <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .::-;-:.IVI ECHANICALPERIUIITA ATI ON;;'.:::::.:;.: . . ..: . . : PLUMBINGIPERINIIT:APPLICATION;: :,:; : : ;:?:;: <br /> Type of Project New Addn (Alterati2__Repair Type of Project __New Addn Alteration „Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures of List of Fixtures #of List of Fixtures <br /> FiXtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> t_ Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower _ Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups _ Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.), Other: <br /> ' . .. ;r':2,iSPRINKi ER 1;SUP PRESSIOIN;SYSTEM;•: : :•:.: <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application and confine the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the work forwhioh application is made, <br /> and I comply with State Contractors Law 18.27 ROW end 296.200A WAC. <br /> (.......____,.........________. <br /> City <br /> of Everett Official—cial Use Only <br /> ik PERM tA' `q , OLA O <br /> Ownef/Authorized Agent Signature `Date (Revised 9123/2016) <br />