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PERMIT APPLICATIO4 <br /> °11111111111:11 <br /> BUILDING/MECHANICAL/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;Only:Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: c:100,'".1 ' i"Tel by" F.,e PROPERTY TAX#:(1)-11.4 I rn <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION.- . <br /> OWNER NAME: 7 Q rt-, in, P Ik(1.7 .l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET i DEQ IL4by. S <br /> CITY'�.'`4`(r.4 k`'+3— STATE 1 Ar A ZIP q R DO R <br /> OWNER PHONE:0-- b8-T77 Yp OWNER EMAIL: Z Pfri tri Li().hm. f 1 i^v. <br /> r <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 E"CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: DAWN WEIMER CONTACT PHONE: 425-2524402 <br /> CONTACT EMAIL: DAWN@GSHEATING.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RESIDENTIAL Contract Price of Work:$ 1 d(000•%---:: . <br /> Proposed Use of Building: RESIDENTIAL Heat Source: OGas DElectric ['Other <br /> Building Type: I2r.SFR-Detached DSFR-Attached ['Duplex DMulti-Family-#of Units: DCommercial Dlndustrial <br /> Type of Project: ONew DAddition 0 Remodel ©Repair Oh. ['Sign ©Sprinkler 0 Demolition ['Change of Use <br /> DESCRIPTION OF WORK: nam acini , , Dototocy, u IIEi-1 + <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 /> #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 I, 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 Hooku s 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 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 1 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 end 296.200A WAC. <br /> City of Everett Official Use Only <br /> \ r 0 ! _j f PE MI V o + O� <br /> AS /tI l k� Y fi�/t/ o f R a <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />