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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> /1111 ."--A CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 [ FAX 425-257-8857 [(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black•lnk Oriily:Please) PROJECT SITE:.INFORMATION <br /> PROJECT SITE ADDRESS: .k = !?YY 1 \ ',-, <br /> � , - -€ - PROPERTY TAX#:(•"fl 1 r,;.(7," f r)i(in <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> :.::.:::CONTACT:INFORMATION <br /> OWNER NAME:,r t-\;�,s c i.\1(14- G,ns.z. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET, 1 t ! H j ,ryi.c.1„ .1kA;), <br /> , <br /> CITY LI:V' - -L-- STATE �V A- ZIP Cid: ,; Y 1 <br /> OWNER PHONE: L4; c- 1 SC) — CI Lj GA 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: 0 OWNER L(CONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> :BUILDINGPERMIT APPLICATION . <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ 4,":"")H . .�c — <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas YlElectric 0 Other <br /> Building Type: C SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ['Commercial El industrial <br /> Type of Project: 12 New ,I3Addition ❑Remodel ['Repair ❑T.l. ❑Sign ['Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:— - ,i <br /> -L-'OtS ltik u\"r 01- 1\4•�. l � 4-' f, i'.� IIP v i -!i'k I �-c,O i'}., -r S�•r�l�x.. <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 _Adds _Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units 1 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 1 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,orf am authorized by the owner of this property to perform the work for which application 1s made, <br /> and!comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> ;r1 n -N ) ) 4 fr) h 1 prrii\iq.0s...c.5-4_ <br /> owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />