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PERMIT APPLICATION <br /> BUILDING!MECHANICAL!PLUMBING 1 SIGN!SPRINKLER!DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAigirX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> Blue or:Black:;Ink Onl" Please PROJECT::SITE;IN FORMATION:': .: <br /> PROJECT SITE ADDRESS: 5U(O 1 S1ni,Y . CV—, PROPERTY TAX#: Ai-K-1ri C(,[i)(? •'.. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) . <br /> CONTACT:::INFORMATION:. it ' <br /> OWNER NAME: ' ,,v,iN\ k'`lA,p,1a; TENANT NAME(If Commercial): ' <br /> OWNER MAILING ADDRESS: s REEr ,--)-,,..I o`)\I 5Necir.c.re: A„.Q, <br /> � is <br /> I <br /> carrp kat A y STATE IP <br /> OWNER PHONE-ti,c--$s-10— a}Ivry+ OWNER EMAIL: <br /> i' <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> orry EVERETT STATE WA ZIP 98201 <br /> CONTRACTOR PHONE: 425-252-4402 CONTRACTOR EMAIL: DAWN@gSHEATING.COM <br /> l . ii , <br /> CONTRACTOR LICENSE#(REQUIRED): GSHEAC*939RK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 019685` ! <br /> If. <br /> PRIMARY CONTACT: El OWNER COCONTRACTOR El OTHER(Please Specify) � ; '`: <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> .......: ..::::: ::::::.::::: .: ....:.....,,.. . .. .. :::.'.;:::.:` :::;BUILDING PERMIT;APPLICATION::-:.,..::;:-::::.:..... .:...... ........ .,:. <br /> l <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ '3CLO. ... :. <br /> r . <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas ,IElectric DOther I I <br /> Building Type: CgSFR-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: _ ❑Commercial I ❑Industrial <br /> Type of Project: EINew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 11. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .•i:� 'l` <br /> ;:;: .--:,.,.:::::PLUMBING'PERMIT.;APPLICATION.;>.:..,::;.::; :::::.:'=.1.;;. '::;::;;::;MECHANICAILIPERMIT: 'I CATION ;:k <br /> Type of Project: _New Addn Alterati�i•_Repair Type of Project: _New Addn Alteration Repair 1 I: <br /> #of o #°f #of I i'. <br /> Fixtures List of Fixtures Fixtures Lrst of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures 11„ I : ;; <br /> A/C—Air Handling Units l; Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal I <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 Tra 1 <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 /> J �. <br /> ::; SPRINKILER:I::;SUPPRESSION<SYSTEM:; : : Il <br /> IChemical or Water I No.of Heads ':. ,'!I': <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true and correct,Work done pursuant to this permit must comply 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.lam the owner,or 1 am authorized by the owner of this property to'perform the work for which application is made, S. <br /> and I comply with the State Contractors Law 18.27 ROW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> /7----______________ (.11 (eitK. <br /> PER I ' L 66, <br /> ,f; :: : _, <br /> Owner/Authorized Agent Signature ' t Date (Revised 9/23/2016) <br /> L <br />