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g. <br /> y <br /> i <br /> PERMIT APPLICATION <br /> `"" BUILDING/ MECHANICAL/ PLUMBING i SIGN/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 1 www.everettwa.gov/permits <br /> O aItus or Bleck ink,only I.R .); PROJECT SITE INFORMATION, <br /> PROJECT SITE ADDRESS:2031 MCDOUGALL AVE 'PROPERTY TAX#:00401541801501 <br /> LEGAL for new construction: Short Plat/subdivision Lot No,.,„ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME ALYSSA HEATO TENANT BUSINESS NAME(Commercial): <br /> OWNER.MAILING ADDRESS: STREET 2031 MCDOUGALL AVE <br /> CITY EVERETT STATE WA zip 98201 <br /> OWNER PHONE: 425-765-0880 OWNER EMAIL:ukhalfus@msn.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY ,,,,,+ <br /> EVERETTWA 98201 <br /> CITY STATE ZIP 1. <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM _.t <br /> CONTRACTOR LICENSE#(REGitJIRED):CMHEAI*09554 CITY OF EVERETT BUSINESS LICENSE#(REQUIRFiD). <br /> 01609$, <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> - <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAI LANA 1CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION ' <br /> Ext$tirtg Use of t3ullding; Contract Price of Work:$4200 <br /> Proposed Use of 8uIdingC Heat Source ❑Gas OElectric 00ther <br /> BUILDING USE: OSFR DTownhouse [DOW Iek ❑ADU ❑Multi-Famit -#Units. ❑Commercial ❑Accesso` Structure <br /> T •e of Prow; ❑New IZIAddition ❑Remodel DRe•air CIT.!, Sign D s=rinkler ❑Demolition OCDart.e of Use <br /> DESCRIPTION'OF WORK: SINGLE ZONE DAIKIN DUCTLESS HEAT PUMP INSTALLATION <br /> ASPCIATED BUILDING PERMIT#(if applicable):; <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures court List of Fixtures Count List of Fixtures Count List of Fixtures <br /> AIC-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 1 Heat Pump&Ductless Dishwasher Sink-Residential(ki• • <br /> s Duct System(Remodel) Refrii oration Drinkinj Fountainlaundry,mop <br /> Exhaust Fans Residentia Commercial Ventilatio Floor Drain Toilet <br /> NMI Exhaust Hood T •e I Not Heat/AC s stem MOE Hose Bibb <br /> IIIIExhaust Hood(Type II) VVater HeaterInterceptor-Grease : - • Repair <br /> Exhaust Hood(Residential) Wood = Interceptor-Sand/Oil 111 Water Service(behind meter) <br /> Forced Air Systems Medical Gas Water Valves - <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> atetSuppresstoit gYStefh, o.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 /> -BulWfri 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, i <br /> *I i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ( City of Everett Official Use Only <br /> PEW\ <br /> ,�z <br /> O 4,/4 /4 7fri.(2.1) 03/08/10 <br /> vineit Authortzed Agent Signature , Date (Revised"1O/tf t f <br /> ;ry <br />