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PERMIT APPLICATION <br /> BU{LD1NG / I1iItl;HANICAL / PLUMBING 1 SIGN / SPRINKLER/ DEMOL{TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE�T, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> (glue or Black Ink'0nly;Please) PROJECT SITE°[NFORMATION <br /> PROJECT 51TE ADDRESS: � �C (��< �-�rJ��.�"L PROPERTY TAX#: �G,�-r����� �i�d�.�.! <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long Iegal description) <br /> CONTACT 1N�ORMATION' <br /> OWNER NAME: �"'� ' TENANT NAME(14 Commercia[): <br /> OWNER MAIL[NG ADDRESS: sraeer �t� c�, a;,�;r� ���'... <br /> � , � <br /> cirv J� �r' sTa,TE ',.�✓�' ziP �� � <br /> OWNER PHONE: �y"? '- � � — ��j OWNER EMAIL: <br /> CONTRACTOR NAME, G&S I-fEATING <br /> CONTRACTOR ADDRESS: sTRe�r 3409 EVERETT AVE <br /> �,� EVERETT sTA;E WA z�P 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONT�cTOR EMA�L: DAWN@gSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRE�;: GSHEAC"`939RK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED}: 01��85 <br /> PRIMARY CONTACT: 0 OWNER C�CONTRACTOR ❑OTHER(Please Specify) <br /> CpNTACT NAME: DAWI�f WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMA[L: DAWN@GSHEATING.COM <br /> BUILDING'PERMIT:APPLiCATION .' <br /> Existing Use of Building: RE5IDENTIAL Contract Price of Work:$ t ' ':�'�a � !�� <br /> Proposed Use of Bui3ding: RESIDENTIAL Heat Source: ,�1Gas ❑Electric DOther <br /> Building Type: C�SFR-Detached ❑SFR-Attached ❑Duplex ❑Muiti-Family�#of Units: ❑Commercial ❑Indusfrial <br /> T pe of P�o'ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.f. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPT[ON OF WORK: <br /> 4���`� C�� ��rl^3,��•' <br /> ASSOCfATED BUILDING PERMiT# if applicable;: <br /> MECHANICAL PERMIT APPLlC T10N PLUMBING'PERMIT APP ��N <br /> Type of Project: New Addn Al�atio �Repair Type of Project: New _Addn _Repair <br /> #of Lisi of Ffxfures r af Lfsf of Fixtures #of List of Fixtures #of �` List of Fixtures <br /> Fixfures Fixtures Fixfures Fixfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> � Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floar Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&disposal Grease Trap <br /> uas Range Ductin Dishwasher Roof Drairs <br /> Clothes Dryer Hcokups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other� <br /> Exhaust Fan Sink{Service/Bar/Mop/etc.} Qther: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water IVo. of Heads <br /> ACKNOWLEDCEMENT:!have�eviewed this application ana confirm fhe informatlon contained herein is true and correct. Work done pursuanf to fhis permit musf comp;y with <br /> cu,�rnnt federal,stafe,and local law.The granting of a permit only authonzes approved wo�k and no deviations therefrom.Deviations must frst be authorized in wnting from the <br /> Building O�cial before being authorized under any circumstance.1 am fhe owner,or!am aufhonzed by the owner of fhis properry to perform the work for which applicaticn is made, <br /> and 1 comp/y wifh the Sfafe Confractors Law 18.27 ftCW and 296.200A WAC. <br /> City of Everett O�cia!Use On/y <br /> PERM T � <br /> �;��---� �,��� ����.,,�� �.G �, <br /> Own�lAuthorized Agent Signature ba�e {Revised 9/23/2016J <br />