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t4t-n- PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN 1 SPRINKLER I 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.gov/permits <br /> (Blue:or;Black_Ink;Only:Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: r',4e Cj 641 f V" .d PROPERTY TAX#:'bpi-XIS- 60 f j ,a) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t@ 'f.Lti1.d1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 'T-1,.AS 2,4 , ,ems <br /> crry . AP.S 1 STA1EI AA,j ZIP c''--.7�,� <br /> OWNER PHONE: kill'/33()---7 Zra...` OWNER EMAIL: <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 ((CONTRACTOR 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:$ lc-7)iii <br /> Proposed Use of Building: RESIDENTIAL Heat Source: ❑Gas Electric ❑Other <br /> Building Type: IiSFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel /IiRepair DTI. ❑Sign ❑Sprinkler ❑Demolition ©Change of Use <br /> DESCRIPTION OF WORK: I <br /> VVVVV�kite 41wate: (-:}ii,NOC\-cui\ALLA' J� <br /> ASSOCIATED BUILDING����"'"``PERMIT'''" #(if applicable): <br /> MECHANICAL PERMIT APPLICATION .. <br /> PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> R, 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 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 298.200A WAC. <br /> City of Everett Official Use <br /> Only <br /> LAN <br /> 1 ,,I. -)k ,\ t nag\26-- <br /> Owner/Authorized Agent Signature Date i, (Revised 9/23/2016) <br />