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Oct. 10, 2017 5: 00PM No. 5956 P. 3 <br /> 44)ERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPER TAX# <br /> o r) 4{ A (, LIwit .f-( 00 TAX <br /> p I\Q"((7 Lo3 <br /> LEGAL for new ( <br /> construction: Short Plat/subdivision Lot No,r (attach copy of long legal description) <br /> OWNER Mu I I / 61.1j S� l I v PhonelE-mai] -f 4o/ <br /> Address qS lO DI(Jfu f1(., 13j,tj, City/State/Zip "t ,r-A <br /> APPLICANT: Owner Owner's Agent X Contractor _Contractors Agent _Tenant(must provide a letter of consent from the own work In the space) <br /> CONTRACTOR G&S HEATING State Lic.# GSHEAC*93ORK City Bus. Lic.# 019685 <br /> Address 3409 EVERETT AVE Phone/Email 425-252-4402 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> DAWN WEIMER 425-252-4402 DAWN@GSHEATINO.COItv <br /> Phone/E-mail <br /> •BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ROC. j ) <br /> Existing Use of Building 14.Ki-7(;t.Q HEAT SOURCE: <br /> Proposed Use of Building GasElectric Other <br /> Building type: _Single Family Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(eddlticrrsl space provided on the back): <br /> Ctv <br /> MECHANICAL PERMIT APPLICATION I I PLUMBING PERMIT APPLICATION <br /> Type of Project: _New. ddn _Alteration_Repair Type of Project _New_Addn Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems _ Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting _ Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other <br /> Number of Heads Other. <br /> • <br /> I hereby certify that I have read and examined this appGcetion and know the same to be true and correct.All provisions of laws and ordinances governing this type of work wit be oompl <br /> with whether ape fled herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am auth ed by the owner of this property to perform the work for which application is made and I comply with the State Contractors Lew 19.27 ROW and 290,200A WAC. <br /> 1011 o n <br /> Owner/Authorized Agent Signature Dat <br /> (Revised 917014) <br />