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14#1677. PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/ PLUMBING /SIGN 1 SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue,or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: a( 0 0Z 2_0l'�D <br /> LEGAL for new construction: Short Plat/subdivision /i Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION , <br /> OWNER NAME: .+ TENANT NAME(If Commercial): Lo CLe.jr <br /> OWNER MAILING ADDRESS: STREET �• <br /> CITY '. �,k;k\- Lk'i L( `Z STATE Z!P <br /> OWNER PHONE: 7 (7", OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> ciTY EVERETT STATE WA ZIP 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@gSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED): GSHEAC*939RK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 019685 <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ '5M-0< Cl 0 <br /> Proposed Use of Building: RESIDENTIAL Heat Source: J1Gas El Electric ❑Other <br /> Building Type: aSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: DNew DAddition ❑Remodel ❑Repair ❑T.l. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> k G>< S, v`2/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION' PLUMBING PERMIT'APPLICATION' <br /> Type of Project: _New _ Addn =Alterati j _Repair Type of Project: _New _Addn _Alteration Repair <br /> #ofList of Fixtures #'of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Hr:ndling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> 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 /> SPRINKLER/;SUPPRESSION SYSTEM <br /> Chemical or Water ' No. of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application and confirm 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./am the owner, or lam authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 16.27 ROW and 296.200A LA/AC. <br /> t City of Everett Official Use Only <br /> \t \\ USIO , C(0 ( <br /> Owner/Authorized Agent Signature nate (Revised 9/23/2016) <br />