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PERMIT APPLICATION <br /> -//4 "---4 <br /> 1041°:— BUILDING I MECHANICAL/ PLUMBING/ SIGN I SPRINKLER I DEMOLITION <br /> 4111111gf 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 Plano.) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:4403 RIDGEMONT DR PROPERTY TAX#:00555600000300 <br /> iLEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) . <br /> , <br /> CONTACT INFORMATION <br /> OWNER NAME: MARK OLSON TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 4403 RIDGEMONT DR <br /> cm( EVERETT STATE WA zip 98203 <br /> OWNER PHONE: 425-750-4847 OWNER EMAIL:Mark@mgolsonlaw.corn <br /> CONTRACTOR NAME:C•M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> cm, EVERETT : STATE WA z‘p 98201 ' <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI*09554 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 016098, <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> 5 .s... <br /> Existing Use of Building Contract Price of Work:$I 000 <br /> Proposed Use of Building: Heat Source: OGas 0Electric 00ther <br /> BUILDING USE: OSFR OTownhouse LiDuplex EADU 0Multi-Farnily-#Units: DCommerctal EAccessory Structure <br /> Type of Project: EDNew ClAddition EiRemodel ORepair DT.I ESign DSprinkler ODemolition LllChange of Use <br /> DESCRIPTION OF WORK: HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> - • <br /> FiXturexture Fixture Fixture <br /> List of Fixtures FiList of Fixtures List of Fixtures List of Fixtures <br /> , COUtif Cairn( Count Count <br /> NC-Air Handling Units Gas Repo Backflow Preventer(Inside BIdg) Shower.Tub,or Combo .., <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,flaor) _ <br /> — A . <br /> Clothes Dryer , 1 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 Ventilatlor Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater . InterceOtot-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 Firepiace/InsertfLog Roof Drains Water Heater <br /> ,.. <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other <br /> Water Suppression System <br /> -Thi,of HeZs <br /> Chemical Suppression System No.of Heads — ..N. <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 /> icument 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 1 <br /> Pudding 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 /> tend I comply with the State Contractors Law 18,27 RCW and 296 2004 WAD, city of of Everett Official Use Only 1 <br /> PER <br /> Owner/Authorized Agent Signature Date (lieviseot0/11012018) <br /> i <br /> i <br /> 4 <br />