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PERMIT APPLICATION
<br /> BUILDING/MECHAN[CAL 1 PLUMBING !SIGN/SPR[NKLER I DEMOLIT[QN
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P}425-257-8840 � FAX 425-257-8857 ((E}everetteps@everettwa.gov f www.everettwa.govlperm9#s
<br /> B1ue'or'Blac ;1" '
<br /> ,
<br /> k nk.Only:Piease °:•..::. PROJECTrSITE>INfORMATION,. ':. ,
<br /> ............ . :...........::....:................. .:.
<br /> PROJECT SITE ADDRESS: ��r',s�.� i^(1r�E t%�72.�c�'LiL� PROPERTY TAX#: i��..��33.��;t,�G���'}��
<br /> L�GAL for new oonstruction: Short P1at/subdivision '� Lot No. (attach copy af long legal description)
<br /> CONT
<br /> . :.:........:::..:.:.:..•:;:::;°:..::::::;:::;::.:;;::;:::::.;:::-.,:.,..,.::,:.::;:,;:;::::::.; ACT.INFORM -. :.::...... ..:.:.,......:.::::::.,::::.":::::...,:.;;;-.:::..,:.::::....:...;..:,.;:.::...:..
<br /> ATION r::
<br /> OWNER NAME: '����;,f�,�/�, `'Ui,�ri,,;��,� � i'ENAM NAME{If Commercial):
<br /> OWNER MAILING ADDRESS: srReEr �(���� "°,''�rt �,�?�,,
<br /> Q�y: U
<br /> CRY .�I'%:v�,�,,-96 STATE 'L, , 21P �r t`�'�+�.
<br /> OWNER PHQ{VE:� (,?-� '�'�'3—��^;!� OWNER EMAIL:
<br /> CONTRACTOR NAME; G&S HEATING
<br /> CQN7RACTOR ADDRESS: srReEr 3409 EV�RETT AVE
<br /> crrr EVERETT srnt� WA zia 98209
<br /> CONTRACTOF2 PHONE: 425-252-4402 COPlTRACTOR EMAIL: bAUUN@gSHEATII�(G_COM .
<br /> CONTRACTOR LICENSE#(REQUIRED): GSI"'IEAC'`939RK C1TY OF EVERETT BUSINESS LICENSE#(REQUIREI7): 019685
<br /> PRIMARY CONTACT: CI pWNER C�(CONTRACTOR ❑OTHER{Please Specify}
<br /> GONTAC'f NAME: DAWI�I 1NEIMER CpNTACT PHONE: 425_2�2�.Q,4O2
<br /> CqNTACT EMAIL: DAWN@GSHEATlNG,COM
<br /> BUILDING:PERMIT; PP
<br /> ::::.:::..::.::::: ::.:-:.;::;:;:.:.:::;::,:;>:.:.;:.::::::;..::::;::::...:::.i:::::;:: ::::::: A 1.1GATION ;..>::::s:.:::.::>.::;;::::::;:::::>:::.:.::::::.:<::::;:::::::.:_.::::::::::>.::,.::.:::::::.,.:.::.::.
<br /> Existin Use of Buildin : RESiDENTIAL Contract Price of Work:$ :>�T'i•��.�
<br /> Pro osed Use ofi Buildin : RES[DENTIAL Heat Source: ,dGas C�Eiectric ❑Other
<br /> Buiidin T e: C$�SFR-Detac. ed ❑SFR-Attached CIDuplex ❑Muiti-Famil -#of Units: ❑Gommeroial ❑Industrial
<br /> T pe of Pro'ect ❑New � Addition ❑Remodei �Repair C1T.1. ❑Si n ❑S rinkler �Demoli#ion C7Chan e of Use
<br /> DESCRIPTIOW OF WOR . � ,.
<br /> �''��.,.�ku�� C�� �f^�-�
<br /> ASSOCIATED BUfLDING PERMIT# if a licable:
<br /> ':;MECHANICQL:PERMIT: P TIONs:;.;:,:::s':..:; :..PLUMBING:PERMIT;ARPL[CATICN:::::.::::::::::::::::.'.:::::::.;:..:.::
<br /> Type of Project: ,,,,W„New,�,_ Add � tteration '�_Repair Type of Project: _New _,Addn _Aiteratfon �,Repair
<br /> Pixtures �st of Fixtures ��res �-ist of Fixtares ��ures �st of Fixtures �� eS List of Fixtures
<br /> A1C—Air FiandEin Units Heat Pump Toilet Backflow Freventer{Inside Btd }
<br /> s Forced Air S stems Unit Heater Bathtub Urinal
<br /> � Gas Pi in Boi4er Lavatory Wash Basin) Drinkin Fountain
<br /> Water Heater Refri eration Shower Floor Drain
<br /> Gas Fireplace Woad Stove Kitchen Sink&Dis osal Grease Trap
<br /> Gas Ran e Ductin Dishwasher Raof Drains
<br /> Clothes D er Hookups Other; Clothes Washer Medicat Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink(Senrice/BadMop/etc. Other:
<br /> SPRINKLER:I.:SUPPRESSION:;SYSTEM;::,°::::° ;:`!:
<br /> Chemical or Water No,oP Heads
<br /> ACKNOWLEDGEMEN7:1 have revlewed this applicatton and ao�rm the information canfained herein is true and correct.Work done pursuant ta fhls permit musi comply with
<br /> cunent federal,state,and local faw.The granting of a permit only aufhorizes approved work and no devfafions therefrom.Deviations must frrst be authorrzed in writing from the
<br /> Building O�cia!before being authorized un8er any eircumstance.!am the owner,or 1 am authorized by the owner of this property to Rerform the work Por which applicafiort is made,
<br /> and 1 compfy with the State Confraetors Law 98.27 RCW and 299.200A WAC
<br /> r City of Evereti Offrcla!Use Only
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<br /> r'� ������ p�'1.� - r�l
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/20t6)
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