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PERMIT APPLICATION <br /> 41/677- BUILDING/ MECHANICAL I PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE;INFORMATION <br /> PROJECT SITE ADDRESS: '?Dr7----) S 1; __ ;''� " ✓i ' � ' 4 <br /> t, + PROPERTY TAX#: p ( ; �, �� ,.�(,�,ti-g0�,; <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT:INFORMATION' <br /> OWNER NAME: -k ' . ¢ ,N z AATENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �f3a i7r,A`.� 9 LX <br /> CITY illi ' STATE ZIP G;A `l <br /> OWNER PHONE: v; L\-aj' 7 �?� <br /> — -! 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): GS H EAC*939RK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 019685 <br /> PRIMARY CONTACT: 0 OWNER aCONTRACTOR 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:$ ASL' <br /> w <br /> Proposed Use of Building: RESIDENTIAL Heat Source: c[C-as CI Electric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,. <br /> '014t,1. �C ��,7'Ld '1'l�`.�-'�✓ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMITiAPPCATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn(Alterati)_Repair Type of Project: _New Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #°{ List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures <br /> NC-Air Handling 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 I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true end 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,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> /,� \ ‘ ic 1211 - 6c1q- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />