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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING/SiGN/SPRINKLER/ DEMOLITION <br /> 1111W <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please):::::: PROJECT SITE INFORMATION :.::.... . . . <br /> PROJECT SITE ADDRESS: j; t^ PROPERTY TAX#:2/307 )-7 O `b f <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: !-1(--k,;/ (y (,�,,-, M TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET-74z(,�,;p C v(c am /+•(^ /� <br /> CITY i--;�/F"d t STATE INA ZIP <br /> OWNER PHONE:t1 S-- t0 — . - <br /> ��� OWNER EMAIL:) �-'tPrat,Art!!`ircrt,(,:,t)/1 <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@gSHEATlNG.COM <br /> CONTRACTOR LICENSE#(REQUIRED): GSHEAC*939RK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 019685 <br /> PRIMARY CONTACT: 0 OWNER E 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:$ 14L63 0f`1 <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas ['Electric ❑Other <br /> Building Type: ESSFR-Detached ©SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: ['Commercial ❑Industrial <br /> Type of Project: Ci New ❑Addition ❑Remodel ❑Repair ❑T.I. ['Sign ❑Sprinkler ❑Demolition ID Change of Use <br /> DESCRIPTION OF WORK: %r- t�, tjUS wno P 4 ChOincie. e . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT PERMIT:APPLICATION ........PLUMBING PERMIT APPLICATION <br /> Type of Project: I New Addn Alteration Repair Type of Project: _New _„-Addn _Alteration _Repair <br /> #ofList 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 /> 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;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 em the owner,or I am authorized by the owner of this properly 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 /> City of Everett Official Use Only <br /> PERMIT# <br /> PiAin 0UJ?I /f H- 12)-lx /, (Uff--®5-y <br /> OwnerlAutho1ized Agent Signature Date (Revised 9/23/2016) <br />