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PERMIT APPLICATION <br /> (467TBUILDING 1 MECHANICAL I PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Skit:.:ciir Black::.Ink.On .::, s .. :::.. ::::::::;.;; . : <br /> nly:Please) PROJECT:SITEtINFORMATfON ;. <br /> PROJECT SITE ADDRESS: 1_,t Li; 91.ii "E PROPERTY TAX#: ti\f i. q `s 641 IOC') <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;CONTACT.::INFORMATION v-.::':.:..,••.:1;:•:.::...:;.::::1::::::-: :: •;:•::, <br /> OWNER NAME: 1 \At\ tia,..z&A)Q4r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 124-1,1.-- ‘gli C (` Y , .L— <br /> CITY :WA 4-- STATE tt/}ya, ZIP q V r <br /> 1.if <br /> 7€e–C <br /> OWNER PHONE: eel-- ) - OWNER EMAIL: I <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: ❑OWNER COCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> 3UILDINGPERMIT.APPLICATION::::: ::: :.:;, . ... <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ . 'fi.). <br /> Proposed Use of Building: RESIDENTIAL <br /> Heat Source: JE1GaS DElectric ❑Other <br /> Building Type: CZisFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ❑New ❑Addition Oemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use • <br /> DESCRIPTION OF WORK: ,-gyp <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . . .r.ii.. MECHANICAL:PERMITtAP CATION: :;: .:PLUMBIN <br /> , ::-::; .:: ,.. ... G.PERMIT;APPLICATION >;,; :: >: ';;; : ;: <br /> Type of Project: New AddnAltera 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 /> NC–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 /> • <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:;:::::•..:.is <br /> !Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT..I have reviewed this application and confirm the information contained herein Is tate 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> r• City of Everett Official Use Only <br /> F,. H V 0 — 09 o <br /> Owner/Authorized Agent Signature Date v (Revised 9/23/2016) <br />