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477 PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN I 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 1(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Blue orBlack Ink Only Please) .. ,.. ..PROJECT SITE INFORMATION . _ • . <br /> • <br /> PROJECT SITE ADDRESS: {; `` vC t,ij-i. 9A�1 PROPERTY TAX#: fir; 5clf l; 0 0 cn r j,,D <br /> LEGAL for new construction: Short Plat/subdivision 0 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ¢tel i k- IAc ti(\p._,A I TENANT BUSINESS NAME(Commercial): 3s,.s 1tr7 .A. p t 4� Fir` ` 4 <br /> E <br /> OWNER MAILING ADDRESS: sTRr ?C`,_ t � 3 i o _ <br /> Crr 4--..-1 it r:I7 Air STATE WA ZIP q 3 zo(c <br /> OWNER PHONE: .kan�_-)(. 4.— ri,c13 OWNER EMAIL: <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: STREET 3409 EVERETT AVE <br /> cm, EVERETT STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:INSTALL@GSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):GSH EAHC821 QR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60058 <br /> PRIMARY CONTACT: ❑OWNER CI CONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE:425-252-4402 <br /> DAWN WEIMER CONTACT EMAIL:DAWN@GSHEATING.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building:RESIDENTAIL Contract Price of Work:$2000 <br /> Proposed Use of Building:RESIDENTAIL Heat Source: ElGas ❑Electric ❑Other <br /> BUILDING USE: EISFR Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: :New ❑Addition ORemodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: REPLACE GAS FURANCE Vj0A A. r/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.PERMIT APPLICATION .. PLUMBING PERMIT APPLICATION • . ... <br /> Fixture Fixture Fixture Fixture <br /> Count <br /> List of Fixtures CountList of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type Il) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> i Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Othen. <br /> Water Suppression System I No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application end 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.1 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 RCW and 296.200A WAC. <br /> City of Everett Offs ia!Use Only <br /> 7, PERMIT# //� U� col <br /> :�� 1 `-'!1"1,611 ., V b <br /> Ownerlf,YGttIC izdjAgent Signature Date L' (Revised 10/10/2018) <br />