Laserfiche WebLink
PERMIT APPLICATION <br /> 4EirBUILDING / MECHANICAL 1 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black.Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:,7Ek;i S (h,:s1 i,)..- Sic- PROPERTY TAX#:incl(A),1 u cirri <br /> LEGAL for new construction: Short Platisubdivisioni Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:1,1 d,tj_^ .h r i 95.4,�,,�c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET , % I ("tiff;5 'i'1 L s-- s+ <br /> CITY fl/y,�/f kVA.- <br /> � STATE 1• 14 zIP Oj,,,2( i <br /> OWNER PHONE: i j•- t;+r;,,�:'.� 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 t CONTRACTOR ❑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:$ '? es* .". <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas electric ❑Other <br /> Building Type: IikSFR-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: }urvew ©Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ['Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIONCel-. <br /> OF WORK: q A <br /> i ledW\{ Lit. c,1:/1-i\t1t- <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 _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 /> A/C—Air Handling Units \ 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 I No.of Heads <br /> ACKNOWLEDGEMENT:1 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 fern 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 /> City of Everett Official Use Only • <br /> PER T <br /> owner Authorized Agbfit Signature Date (Revised 9123/2016) <br />