Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> 40111 <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 wvrw.everettwa.gov/permits <br /> (Blue or Black Ink Only P1si�sa) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:5009 23RD AVE W PROPERTY TAX#:00644500001800 <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> i <br /> OWNER NAME: BOB KELLY TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET5009 23RD AVE W <br /> air EVERETT STATE WA zra 98203 <br /> OWNER PHONE: 425-359-0912 OWNER EMAIL:Kelly.ryanm@gmail.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY I <br /> --i <br /> cin. EVERETT STATE WA VP 98201 <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI`09554 CITY OF EVERETT BUSINESS LICENSE fi(REQUIRED): 016091,4 <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE:425 259 0550 <br /> KAILANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$13,000 _ ........... <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: DSFR ❑Townhouse EifrIDuplex 'EDU ❑Multi-Farni# #Units: ❑Commercial L-Accessor'Structure <br /> Type of Project: ©New ©Addition (Remodel ORepair [DTI. LSiln 'Sprinkler ❑Demolition ❑Chane of Use <br /> DESCRIPTION OF WORK: ' <br /> LIKE IN KIND GAS FURNACE CHANGE OUT WITH HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#{if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture FIxturo Fixture Fixture <br /> Count List of Fixtures Count List 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 Ventilatior 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 1 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 taw. 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 i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> j ,� �ry -'���/� PENT#(1 t t �. <br /> Cf-..CY . Y f11-0/1/ 110/09/19 <br /> PMT <br /> 1 o - CH g <br /> Owner/Authorized Agent Signature Datev T <br /> (Revised 10/10/2018) <br /> 1 <br /> i <br /> f <br /> -' K <br />