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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> } 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810.J FAX 425-257-8857 1(E)`merotf ri=verettwa,gov j www.everettwa.gov/permits <br /> (Blue or Black Ink Only P w), PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:91 5 RUCKER AVENUE PROPERTY TAX#: ; <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:. JAMES RUDOLPH <br /> TENAN7 BUSINESS NAME(Commercial): <br /> .... <br /> ;OWNER MAILING ADDRESS: STREET.:.915 RUCKER AVENUE <br /> cm EVERETT STATE WA zip 98201 <br /> OWNER PHONE:206-226-5588 OWNER EMAIL: <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: smser <br /> 1415 BROADWAY <br /> cm EVERETT STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:DEBBIE@CMHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI*09584 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 /> DEBBIE CONTACT EMAIL:DEBBIE@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existing,Use of Building: Contract Price of Work:$5400.00 <br /> ,Proposed Use_of Building Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: OSFR DTownhouse ❑Duplex ❑ADU ❑Multi-Family-#Units M, _„.._M„ ❑Commercial DAccessory Structure <br /> Type of,Project.::❑New : :.❑Addition DRemodel 0 Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: REPLACE GAS FURNACE <br /> ASSOCIATED BUILDING PERMIT#(If ppht able)' <br /> A <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture List of Fixtures Cx <br /> Count Count otun� List of Fixtures Fixture List of Fixtures <br /> NC-Air Handling Units Gas Piping Backflow Preventer(Inside Bidg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink=Commercial(3-comp,prep,floor) " <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residentiat)� Commercial VentilationFloor Drain,::: Toilet <br /> Exhaust Hood(Ty.e I) Not Heat/AC s stem . 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 /> I ForcedAirSystems - 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 /> {+eater Suppression,.System 1Vo.oTH ads <br /> Chemical`Suppression ystem o.o '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 i, <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 t comply with the State Contractors Law 18.27 RCW and 296,200A WAC. ""f' <br /> City of Everett Official Use Only <br /> } PERMIT t2 - 01 <br /> 2/7/19 <br /> Owner/' uthorized Agent S'nature Date <br /> Datelsed <br />