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PERMIT APPLICATIOII <br /> BUILDING/MECHANICAL 1 PLUMBING 1 SIGN/SPRINKLER/DEMOLITION <br /> /14,/-74 CITY OF EVERETT PERMIT SERVICES <br /> .."- <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 /> (Blue or Black Ink Only Please) .:..,.. PROJECT SITE.INFORMATION <br /> PROJECT SITE ADDRESS:Li,,a M 4,r tvt PROPERTY TAX#:k1C)'1 fl gni F,D LL..CX <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,Sr ;' i P(16, f\ : TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET-4`j � H p 1(rrlon... /- <br /> (` f <br /> p(�� <br /> CITY EVA°i— • - �STATE � • <br /> ZIP q C}� 3OWNER PHONE:L -Oj 5q1- 1(r OWNER EMAIL: c wU {j c_ .,'--j W 1 U 1..(j. -z C. ry1 <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> CITY EVERETT STATE WA DP 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/ O\'2;)741'2;)741 /41-Ca \\ <br /> Existing Use of Building: RESIDENTIAL Contract Price of, ork:$ �'r ---— i.- #, ) <br /> Proposed Use of Building: RESIDENTIAL Heat Source: a 4-- I -- ---- =:1 <br /> Building Type: CIKSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel CI Repair DTI. DSign ❑Sprinkler ❑Dem olition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project.New _ Addn Alteration 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 I 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./: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.lam 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 /> cl,� ((�� ``��ee PERM'M 6�,i <br /> 'OwneilAuthorized AgenTSignature Date (Revised 9/23/2016) <br />