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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN /SPRINKLER 1 DEMOLITION <br /> 'e4111.4010C-g. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: S `i c;h Atii. PROPERTY TAX#: ( '1 , <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> <:CONT O <br /> .. ..:....:... <br /> OWNER NAME: J 4w\ C Y,;s;at,vr\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �1 J\ � ‘AA r <br /> CITY STATE iLL.J ZIP ../:::\IC‹.7cli <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cm' EVERETT STATE WA ZIP 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: 0 OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> ;:ar BUILDING'PERMIT=APPLI <br /> .::::......... .. ..,...: :...::. ..:..:.. ..,,.:.........:. CATION::;: :::::::._.;._::.;;.>::::;::r::::..:::::::::::..............:-:.........,.,,....,,.:::,...,........, <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ CC/$. 0 <br /> Proposed Use of Building: RESIDENTIAL Heat Source: �as ❑Electric ❑Other <br /> Building Type: arsFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> CcC <br /> i i r' � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> c.; MECHANICAL::`PERMIIT.APPLI ::>:.;.: `::.,....:::•:- <br /> CATION ::.::..:..:::.::::,:;;::.:::::::.: :PLUMBING::PERMIT:'APPIiCAT10N <br /> Type of Project: _New Addn ' ? Repair Type of Project: New Addn Alteration _Repair <br /> #of list of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 I No.of Heads <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.I em the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM T <br /> i 712)k 1 k4o <br /> Owner/Autj 6rizedA`ent Signature Date (Revised 9/23/2016) <br />