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PERMIT APPLICATION <br /> BUILDING/MECHANICAL i PLUMBING/SIGN 1 SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3290 CEDAR STREET,EVERETT,WA 98204 <br /> (P)425-257-8840 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blueor`Black`.Ink:Only::Please}:: PROJECT SITE INFORMATION :• <br /> PROJECT SiTE ADDRESS: 1_,k) jcc PROPERTY TAX#: u; -c'SCfii C 3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT:INFORMATION.. <br /> OWNER NAME: W f , i , .t:v TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET laPAR ,n rUZ' K <br /> CITY A ,I iv STAT L A ZIP c-73, <br /> OWNER PHONE:LA.`�\- t(O )— ') ?% OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> CITY 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 C (CONTRACTOR 0 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:$ J l. _ <br /> r <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ,C]Gas DElectric ❑Other <br /> Building Type: C SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel .- epair 01.1. ❑Sign OSprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: `r <br /> acv <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .::MECHANICAL;:PERMIT'APj-CATION PLUMBING PERMIT:APPLICATION <br /> Type of Project: _New Addn Alterati _Repair Type of Project New _Addn Alteration Repair <br /> #of *of Fixtures #of List of Fixtures List of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-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/Mo /etc.) Other: <br /> SPRINKLER€l;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 am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW end 298.200A WAC. <br /> City of Everett Official Use Only <br /> PEiy{Ev�#� ��' �1n <br /> ti R J <br /> Owner/Authorized-Agent-Signature 'Date (Revised 9/23/2016) <br />