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4re"77 PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -LD _1,ttaiitlei D PROPERTY TAX#: 1:to�j. ki I Cep 60u6 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Paha.- C(A ,(,g, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ' Gpj p{`� ckgf1. Q( <br /> CITY ' ,4,i_iti--tte,�- I ..1� Cift STATE ZfP <br /> OWNER PHONE: L& •7)'.�--'J i,1( V `r OWNER EMAIL: <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cn-r EVERETT STATE WA zrp 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 COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-252-4402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ 2.1)-Y% -Th' <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas Electric ❑Other <br /> Building Type: CgSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial [Industrial <br /> Type of Project: ❑New EAddition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT A- - ATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Altered• _Repair Type of Project: New Addn Alteration _Repair <br /> Fi r f List of Fixtures Fixtures List of Fixtures ofFixtList of Fixtures xtes Fiu s List of Fixtures <br /> reNC—Air Handling Units k Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory ash 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 INo.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 end 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 I 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 RCW and 295 200A WAC. <br /> City of Everett Official Use Only <br /> / F PE V 1 1#\9LCo <br /> e. D�� <br /> Owner/AutJk <br /> ed Agent Signature D e (Revised 9/23/2016) <br />