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j-roiskVPERMIT APPLICATION <br /> � BUILDING I MECHANICAL 1 PLUMBING I SIGN/SPRINKLER! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 , <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govlpermits <br /> (Blueo`r;;8lack',Ink`Onh' Please'>:;;:;:;;r;::::;;:;::PROJECT..SITE:.INFORMATI <br /> _. <br /> PROJECT SITE ADDRESS:''S-1[st ( ;m G PROPERTY TAX#: F AC' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT;INFORMATION <br /> OWNER NAME: (;),( . Ire. +.-CA,� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: Tram j�(t. %zno ,�keA ,/ „._ <br /> cnm ("- t STATE (4. ZIP S <br /> OWNER PHONE: cm----,,Liy e7 OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: sTasFr 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: ❑OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-2524402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> BUILDING:PERMIT.::APPLICATION <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ ('-i "iTz—O <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas _lectric ❑Other <br /> Building Type: I SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑AdditionRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> V., ir:IVIECHANICALPERMIT:.;APPLICATION;? :':,.:: ;;:r:;;::::::,- ;: :::PLUMBING:`-PERMIT:APPLICATION: :=:: s>::;'. <br /> Type of Project: _New_ Addn AI tat _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of 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 /> : SPRINKiERr1:SUPPRESSION;'SYSTEM :;;:r. <br /> !Chemical or Water I No.of Heads r <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!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 and 296:200A WAC. <br /> t <br /> City <br /> l'ofEverett <br /> �JOfcial Use Only <br /> c__ ... r PERMIT i,I / V g I : OZ7 <br /> Owner/A razed Aget Signature Dat (Revised 9/23/2016) <br />