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Ap r, 26. 2017 1 : 07PM No, 5223 P. 1 <br /> PERMIT APPLIC�ITION <br /> ��11LDING/MECHANICAL/PLUMBING/SFGN/SPRINKLER/DE1VrOL��TION <br /> CITY OF EVERETT PERM[T SERVICES <br /> 3200 Cedar St., Everett,WA 9820� 425-257-��10 FAX 425-257-8857 www.everettwa.org <br /> SITE AbDRESS: PROP�RTY TAX t� P # <br /> ��2.��� � S�us' l �,, � - �� �-(—D � <br /> LEGAL for new consfruction: Shv�t Platlsubdivisio� Lot No. (artach copy of long legal description) <br /> OWNER /LJI.� Phone/E-mall �"'�Z.�-'J�J"�-" �1„f� <br /> Address �'Z� � City/Stdte/Zip . � • �S( , <br /> APPLICAN[T:_Owner _Owner's Agenf X Contractor �,Contracfors Agent _T2t1�f1X(Musf p�ovitle a IeHet of eansentfrom the owner to tlo work In Ne spsce) <br /> CONTRACTOR G&S HEATWG State�ic.# GSHEAC"'930RK Clty Bus. l.ic.# 019685 <br /> Address 3409 EVERE�'7 AVE Phone/Email 425-252-4402 <br /> TENANT BUSINESS NAM� CONTACT FOR PERMIT <br /> DAWN W�IMER 425-252-4402 DAWN@GSHEATIN .COI� <br /> Pnone/E-mail <br /> BUILDING PERINI'C APPLICATION GONTRACT PR10E OF WoRK I f,�,%f i�jC).O!'� <br /> Existing Use of Bui[ding HEAT SOURCE: <br /> Proposed Usa of Building Gas Eiectric Othar <br /> �uilding type: _Single Family Duplex Townhouse _Multi-Family �Comm�rcial <br /> T e of ro'ect: tJew Additio Remodel Re air T,I, Si n S rinkler Demolitian Chan e of Use <br /> D�SCRIPTION OF WOR i lonal space provided on fhe back): <br /> ��� ������ . <br /> �VIEGHqN1CpL PERMy'r AP�LICATION PLUMBINC� PERMIT 4PPLICATION <br /> Typs of Project: _New_Addn �teratio _Rapair Typs o(ProJect: _New�ddn �4ltera4ion_Repair <br /> Show Number(# of f Show Number # vf fixiures <br /> A/G—air handlin uni#s Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Watef heater Shpwer <br /> Gas fire [a�e Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e h0od Water heater <br /> Exhaust fan Sink service/b3r/mo letc. <br /> Heat um BaCkflow reventer <br /> Unit heater UCiRaI <br /> Boiler p�[nkin Fountain <br /> Refri. erstion Floor drain <br /> Woodstove Grease#ra <br /> Ductin Roof drains <br /> Other Medica[Gas <br /> SPRINKLER/ SUPPR�SSION SY�TEM other: <br /> Number of Heads Other, <br /> I hCreby Celtlry�hst I have read and examined this applia3tian and knoW tlle same to be lrue and correct.Ail provlslon9 of laws and ordinancas governing this type of work will ba compl <br /> wdh whether specified herein ot not.TI1e grdnting of a permit does not prasume to give authority io violafe o��anCCi the proViaion of any othet State or lo�l��.v regulsting construntion <br /> Tltat I am authorizeq by the ownar of this pr�perty tv pz�form the worKfor whiclt appliCBtlen f�msde snd I comply with the State Contraclors Law�8.27 RCW end 296200A WAC. <br /> Cwn /A orized Agent Signaturo Date (Revlsed 9/2014) <br />