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PERMIT APPLICATION <br /> 194rEn" BUILDING /MECHANICAL i PLUMBING/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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or:Black:Ink:'On '';:Please ::: :;:::::::;:,. .........:: <br /> IY. )..... :...:...........PROJECT;`SITE::INFORMATION:+ :::: : ::::,:.>;:.: :: :::;,: ;:::::::;;;:;._:; ; ::; :;::: :;;: : <br /> PROJECT SiTE ADDRESS: 1 Pfil r":' k PROPERTY TAX#: C4L4\--cii t3t7,2(1.7):7 0"3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,..:.... . ONTAC. ; <br /> _...:......:_ .........:.. .........:... .. .:........ .... T..INFORMATiON ;:. :;;:: :�:::::.:.::::::; ...,: .:,:;: - : ::: ::; .:.: : : : : ; .:: : . .-.. <br /> OWNER NAME: Cj xitt �M TENANT NAME(If Commercial): <br /> '^ _1 6 V( ' <br /> OWNER MAILING ADDRESS: STREET ��, <br /> CIT' ��������.ti� STATE � 1 ZIP ��`�?i')'W <br /> OWNER PHONE I\-'3ICA -• b1p2. 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: D OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAiL: DAWN@GSHEATING.COM <br /> ;:: .:;:: ::.::::. .,..s: ::: ::: : :.:::::-:: :::; :_ --::::.;:: ::- : APPLICATION::._;:::::..::.:: .:.: :;:. <br /> RESIDENTIAL ^� O <br /> Existing Use of Building: Contract Price of Work:$ ... ��_�n <br /> Proposed Use of Building: RESIDENTIAL Heat Source: as Electric ©Other <br /> Building Type: C$"SFR-Deta ed ❑SFR-Attached ❑Duplex DMulti-Family-#off nits: DCo al Dlndustrial <br /> Ty e of Project: ©New LJAddition ©Remodel ❑Repair ❑T.I. ❑Sign DSprinkler DDemolition CDChange of Use <br /> DESCRIPTION OF WORK( <br /> ci-Okel r <br /> ASSOCIATED A ED BUILDING PERMIT#(if applicable): <br /> ME <br /> CHANICAL.P <br /> ERMIT:AP `IC T <br /> ;:-:..: :: .::'. :: :';:°:.:..:::::.::.PLUMBING:PERMIT:APPLICATI ;; :;'.:' : :;: :;: ;:::' ' <br /> Type of Project: New — Addn 'Iterati Repair Type of Project New _Addn _Alteration Repair <br /> #of List of Fixtures 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 /> t 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 /> :.:;';!:SPRI NKLER:J:`:SOPPRESSION 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 am the owner,or!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 298.200A WAC. <br /> r City of Everett Official Use Only <br /> , PERt Lie <br /> # t q <br /> Owner/Authorized Agent Signature Da e (Revised 9/23/2016) <br />