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PERMIT APPLICATION <br /> #111/411%—P— BUILDING I MECHANICAL/PLUMBING 1 SiGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 I(E)everetteps@everettwa.gov l vvww.everettwa.gay/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ^�y ir! to -2-1,-.‘",k- + PROPERTY TAX#: Ca kIl ) Op;MS-16 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �L 11.0^L;li^ai y`.s ', /mss , TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET , j`f., O k, \) <br /> CITY STATE WA zip 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: STREET3409 EVERETT AVE <br /> cow EVERETT STATE WA , ZIP 98201 <br /> CONTRACTOR PHONE:425-252-4402 CONTRACTOR EMAIL:INSTALL@GSHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):GSHEAHC82I QR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60058 <br /> PRIMARY CONTACT: 0 OWNER 0 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: OGas ❑Electric ❑Other <br /> BUILDING USE: CISFR ETownhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project ❑New ❑Addition ID Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: . . <br /> \yc <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture <br /> Fixture List of Fixtures Fixwre List of Fixtures List of Fixtures List of Fixtures <br /> Count Count Count Count <br /> NC-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler as -a • _ Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Duct.1: Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) _e rig 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 II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> 1r Forced Air Systems Other. Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER 1 SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 l 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 RCWand 296.200A WAC. <br /> City of Everett Official Use Only <br /> y PER VIA Aoairow.4 onwNweu En k \\ el 00?-m2,, I <br /> DAWN WEI�IE o• • ozaa+zoaasArcr <br /> Owner/At i e 'Agegtiignature Date (Revised 10/10/2018) <br />