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PERMIT APPLICATION <br /> 'IP' BUILDING / MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ 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:1617 RUCKER AVE PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision_ Lot No._ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TARA ROHRBACH TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1617 RUCKER AVE <br /> ciTr EVERETT STATE WA ZIP 98201 <br /> OWNER PHONE: 206-898-7222 OWNER EMAIL: <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 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*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 /> DEBBIE CONTACT EMAIL:DEBBIE@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$4750.00 <br /> Proposed Use of Building: Heat Source: tit0as ❑Electric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑iDupiex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Ty of Project: ENew ❑Addition ❑Remodel ❑Repair CIT.!. LlSi;tn ❑Sprinkler ❑Demolition LlChange of Use <br /> DESCRIPTION OF WORK: REPLACE GAS FURNACE <br /> ASSOCIATED BUILDING PERMIT#(if appliicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—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 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 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 /> 1 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: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 1 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 296.2004 WAC. <br /> City of Everett Official Use Only <br /> e,..,....„ <br /> f PERMIT# <br /> i at <br /> tor 7 ,,, 2/6/19 m \oz - or 2 _ <br /> ,OwneriAuth=rued Agent Signature Date (Revised 10/10/2018) <br /> 111 <br /> 1 <br /> I <br />