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PERMIT APPLICATION <br /> BUILDING :CHANICAL / PLUMBING / SIGN / ZINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> 1�.'"1:.,: � E �:� �. ;�..� � ,.� r�.7< P�` ��'�j' . <br /> PROJECT SITE ADDRESS: , � •��'��,, , i.�:^.,�.� �_; + PROPERTY TAX#: ' ` '(�.J�:r _ <br /> LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET . � �..J <br /> CITY — .;__�_��� �* STATE (,' •�" ZIP �� 'i-? <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: sTReer 3409 EVERETT AVE <br /> ciTv EVERETT srnrE WA Z,P 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: ❑ OWNER C�CONTRACTOR ❑ 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: $ � G ce' <br /> Proposed Use of Building: RESIDENTIAL Heat Source: `Gas ❑Electric ❑Other <br /> Building Type: C$�SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: s, <br /> � � <br /> �� 1 <br /> ���c�-- �.:�,�.41 {-� �,�;�= �;�iz,�... ��` 1�.� �-�; <br /> ASSOCIATED BUILDING PERMIT# if a plicable : <br /> MECHANICAL PERMIT ARPL-E TION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration ��' Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of Lisf of Fixtures #�f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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 No. of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comp/y 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 1 am authorized 6y the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> r,/ �`� City of Everett OKicial Use Only <br /> � PERMIT <br /> � __� ._ ;�-i a�1 (� ���1 I �l I Z�� ���� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />