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PERMIT APPLICATIM
<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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE ADDRESS:6514 HIGHLAND DR PROPERTY TAX#:00531700400101
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: JOE/SANDRA KUBIN TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: sTREET6514 HIGHLAND DR
<br /> cnv EVERETT STATE WA ZIP 98203
<br /> OWNER PHONE: 425-347-1170 OWNER EMAIL:kubinsjk@comcast.net
<br /> CONTRACTOR NAME:C.M. HEATING INC
<br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY
<br /> cry 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: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-259-0550
<br /> DEBBIE CONTACT EMAIL:DEBBIE@CMHEATING.COM
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<br /> Existing Use of Building: Contract Price of Work:$5200
<br /> Proposed Use of Building: Heat Source: ElGas ❑Electric ❑Other
<br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure
<br /> Type of Project: ❑New ❑Addition ERemodel ❑✓Repair DTA. ESign ❑Sprinkler DDemolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> GAS FIREPLACE INSTALLATION
<br /> ASSOCIATED BUILDING PERMIT#(if applicably:
<br /> 7 21 IEC AN, AL„1 , .i 4.000 dNW... ,; . e r , ._ ._°,v1 1 1 E.10.'**Olitt,yAi ` 1 ` 0IiI[,Aa'itent
<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 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 /> 1 Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> ,*0111. k ER 1,S1>rPPRESSIO*5t1 `tE,fCAR, 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 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 /> 449.4 77itlaJ PIS#vi, 0C�
<br /> 11/18/19
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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