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PERMIT APPLICATION <br /> /"'� BUILDING 1 MECHANICAL 1 PLUMBING/SIGN 1 SPRINKLER 1 DEMOLITION <br /> IIP"I a _, CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everettepseeverettwa.gov I www.everettwa.gov/permits <br /> (Blue oriBlackank>Olnly Please).::::.: ::::.::.::::..:.:PROJECT SITE INFORMATION . <br /> •PROJECT SITE ADDRESS: `")qQE PROPERTY TAX It: 00-1`1 (S 0000114) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: S AwTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:LursZ goas--- i 610 1S" <br /> cnY rEreyeAt STATE 'vPJ 21P �g�0-g <br /> OWNER PHONE:%y,3-L4(Dq—�J—t0q �, 11 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: El OWNER I(CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> ILD NG:PERMIT.APPLICATION :::.... . <br /> .. . . . . ........ .. <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ .ca. <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas 0 Electric DOther <br /> Building Type: aSFR-Detached DSFR-Attached ❑Duplex IJMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair 01.1. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION Project:? <br /> WORK: <br /> L ct 616nd $n-go% trAs -ivyna4 CC)k- <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 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 /> : :SPRINKLERJ.SUPPRESSION SYSTEM <br /> Chemical or Water j 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,end 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.!am the owner,or l 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 /> PERMIT# <br /> ( cf,A. Qt10-?(a-)B ( g1 O -0(00 <br /> Owner7Authorized Agent Signature' Date (Revised 9/23/2016) <br />