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PERMIT APPLICATION <br /> 4V41641,--.4 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 FAX 425-257-8857 1(E)everetteps@everettwa.gov l www.everettwa.gov/permits <br /> (Blue::ar Bllack:Ink:.Only;Please) : .;. PROJECT.SITE INFORMATION .:.. ........ .: . . <br /> PROJECT SITE ADDRESS: LIr1,jp ' ,4,k A , 2....' PROPERTY TAX#: 015-sal``•j,C:Eld.,.ct+i..> <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) . <br /> OWNER NAME: kj.M IAA Ci;."\kk k,( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .\--MAI 3 t'1A -, <br /> ',,,...A—„, <br /> tx <br /> Lk- <br /> CITY � STATE ZIP qt,-,--„-,A3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> CTv 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 ((CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 4255-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> .BUILDING;PERMIT.APPLICATION <br /> Existing Use of Building: RESIDENTIAL Contract Price ofWork:$ 'Li 15- <br /> Proposed Use of Building: RESIDENTIAL Heat Source: /(Gas ❑Electric ❑Other <br /> Building Type: aSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler El Demolition CI Change of Use <br /> DESCRIPTION OF WORK: T. <br /> •zr <br /> ;v i^ak.fi.,lir � ,`r <br /> v. <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL.PERMITAPPLICATION::.....:. .....:.PLUMBING.PERMIT APPLICATION.. ::; :..: : :::::: <br /> Type of Project: _New_ Addn Aeration> 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 /> 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/Mop/etc.) Other: <br /> ;::.`;SPRINKLER`/:SUPPRESSIONSYSTEM <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 I 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 ROW and 296.200A WAC, <br /> j City of Everett Official Use Only <br /> IS/1(\ ___ <br /> l " PER\` ^ ( <br /> :?.� �--' �� <br /> .,. <br /> p R YY \`s1 <br /> ii1d�,1 ',s tytC1* <br /> OwneriA'uthorized Agent Signature Date (Revised 9/23/2016) <br />