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PERMIT APPLICATION Hz <br /> IIz <br /> BUILDING 1 MECHANICAL 1 PLUMBING 1 SIGN/SPRINKLER/ DEMOLITION <br /> °Pd.:4CITY OF EVERETT PERMIT SERVICES <br /> vidi3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> Bltie:or% t <br /> B aak 1e ::: <br /> Oni ..Please ::::..:::::.:.::..:...>::::: �:. ..: . <br /> � PROJE : . <br /> PROJECT SITE ADDRESS: c--3(O ),g-` ALL.LAD PROPERTY TAX#: �r'' , ,7Cp��,�(,,, „R ;e-:1 <br /> • <br /> LEGAL for new construction: Short Plat/subdivislon Lot No. (attach copy of long legal description) <br /> ... TA <br /> CT.INF.O <br /> OWNER NAME: A, \\.. 0,P4k ,. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '4--.7.41 '2��v • ?r, <br /> CITY to ft fisc- STATE .... -.. ZIP CP 7,Zi3 <br /> OWNER PHONE: " ��' (�"f, t 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: Cl OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> BUIlD1 <br /> .APLITIO CA N. <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ 1', <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas Electric LI Other <br /> Building Type: CZ/SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project ❑New []Addition CI Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Cu.r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> Type of Project: _New _ Addn AIteration <br /> Repair Type of Project: _New Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures FixturesList of Fixtures Fixtures List of Fixtures <br /> NC—Air Handling Units t! Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 /> SPRIN RASUPPRESSION SYSTEM)I'i::`:;;! <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application end 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.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Lew 18.27 RCW and 296.200A WAC. <br /> City <br /> ofEverett Official Use Oniy <br /> 2. \ PER <br /> Owner/Authorized Agent Signature . Date (Revised 9/23/2016) <br />