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PERMIT APPLICATION <br /> A BUILDING I MECHANICAL i PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> "Ill �_ CITY OF EVERETT PERMIT SERVICES <br /> " 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j 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:3504 30TH AVE PROPERTY TAX#:01162800003300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .... .....CONTACT:INFORMATION <br /> OWNER NAME: AMBER MCPARTLAND TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET3504 30TH AVE <br /> cry EVERETT .STATE W ZIP 98201 <br /> ` <br /> OWNER PHONE: 425-239-4262 OWNER EMAIL:AMBER_MCPARTLAND@YAHOO.COM <br /> CONTRACTOR NAME:GS HEATING <br /> CONTRACTOR ADDRESS: STREET3409 EVERETT AVE <br /> CIT, 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: 0 OWNER El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-2524402 <br /> ALIS HA CLOGSTON CONTACT EMAIL:ALISHA@GSHEATING.COM <br /> BUILDING INFORMATION . <br /> Existing Use of Building:RESIDENTAIL Contract Price of Work:$9146.01 <br /> Proposed Use of Building:RESIDENTAIL Heat Source: ❑Gas ElElectric ❑Other <br /> BUILDING USE: EiSFR ❑Townhouse EDuplex EADU DMulti-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New ©Addition ❑Remodel ❑Repair ❑T,l. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: INSTALLATION OF NEW DUCTLESS HEAT PUMP ON BACK PATIO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fra„r, Fixture Fixture <br /> Count List of Fixtures CountList of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—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 i 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 Vent latior 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 /> 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 Other. <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:!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, kd 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 ing authorized under any circumstance.I am the owner,or I am authorized byby the owner of this property to perform the work for which application is made, <br /> and 1 comply with the St a Contractors Law 18.27 RCWand 296.200A WAC. <br /> City of Everett Official Use Only <br /> kc..t.oct, .._1 LS PR Ttat off <br /> (? <br /> Owner/Autbhr,3 ' int Signature v Date I T (Revised 10/10/2018) <br /> ft <br /> V <br />