Laserfiche WebLink
PERMIT APPLICATIOPIJ <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> Imo'"i---A..7- 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 Jhk Only(Please) :j PROJECT SITE:INFORMATION <br /> PROJECT SITE ADDRESS: 93 ( ,..Z 2./d 5j PROPERTY TAX#:(Th.c)I I( ci C 7Cfl ( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ....;.: ... .CONTACTINFORMATION .. <br /> •OWNER NAME: 1 erre no,. -To ,v- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '(n <7;r01 s - <br /> crY E>C, .,.4..- STATE IATA ZIP 0!6 0 0 l <br /> OWNER PHONE:SA.0; ,q—1 R..j 1 OWNER EMAIL:TILT 1 g 1 f (c�hc+ry-No i 1 - C.1 ry i <br /> CONTRACTOR NAME: G&S HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> CITY EVERETT STATE WA MP 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: 9 OWNER EXCONTRACTOR 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:$ j 10L1 q q <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas 2ectric ❑Other <br /> Building Type: [$SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units:_ _ ❑Commercial ID Industrial <br /> Type of Project ['New ❑Addition ❑Remodel ❑Repair 01.1. ❑Sign OSprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK:©V.\- Un t An/ �,�, �'y �\* <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> : AN CAL:PERMIT:°APPLICATION <br /> ;..::'::...: :.:.:: ::PLUMBING:PERMIT APPLICATION ;::.:::::.::-; .;:: <br /> Type of Project: _New 4. Addn Alteration Repair Type of Project _New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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,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 296.200A WAC. <br /> �j p City of <br /> Everett�Official Use Only (n <br /> St0A,trkk: C) r' -d gi 1 q „19 PERMIT ZOCI —. U�`� <br /> Owner/Authorized Agent Signature Date (Revised 9!23/2016) <br /> ...................................................................... <br />