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PERMIT APPLICATION <br /> ,, . BUILDING/ MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vtigi 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps e@everettwa.gov I www.everettwa govfpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:808 55TH PL SW#B PROPERTY TAX#: <br /> LEGAL for new construction: Short Piatisubdivision Lot No. (attach copy of long legal description) <br /> a <br /> ,r <br /> CONTACT INFORMATION <br /> OWNER NAME: SUE HOLDMAN TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET808 55TH PL SW#B <br /> cm' EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: 425-338-0804 OWNER EMAIL: <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> CITY EVERETT <br /> 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: ❑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 /> Existin• Use of Buildin.: Contract Price of Work:$2900 <br /> Proposed Use of Building: Heat Source: ❑Gas []Electric DOther <br /> BUILDING USE: LISFR ❑Townhouse EDuplex LIADU ❑Mutt(-Famy-#Units: ❑Commercial EAccessory Structure <br /> Type of Project' ❑New ❑Addition ❑Remodel k✓)Repair ❑T.I. Sign LJSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: REPLACE ELECTRIC FURNACE <br /> ASSOCIATED BUILDING PERMIT# if a.•liceble): <br /> MECHANICAL.PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count count List of Fixtures Count List of Fixtures Count <br /> List of Fixtures <br /> ,NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) _Shower,Tub,or Combo <br /> Roller 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 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 /> 1 rorced Air Systems Other: Medical Gas p Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM _Sewage Ejector or Sump Pump Other: <br /> ,tater'-adi I coil System No.of Heads <br /> I Ni. , esslon 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# ' 4 <br /> „$„„r ri Fithnrized Agent Signa re Date (Revised 10/10,2018) <br />