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PERMIT APPLICATIOA
<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 /> �ta�k� f 1► ..il► ,.. ...y 41OJECT SITI 001004407,ll
<br /> PROJECT SITE ADDRESS:3306 NORTON AVE PROPERTY TAX#:00437578602600
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> '.. e.,� .. ,.raxv�, 1i � Vie.. .. „3 f g ,.a-d«}� Mt-0,0111:190116016:601100 1 .. f .... . k ly' ' y\ YY .. ..s,
<br /> OWNER NAME: GREG BENSON TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET3306 NORTON AVE
<br /> cry EVERETT STATE WA ZIP 98201
<br /> OWNER PHONE: 425-367-1377 OWNER EMAIL:bensonware@outlook.com
<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:KAILANA@CMHEATING.COM
<br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI*09554 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 016098
<br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-259-0550
<br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM
<br /> •. so.., ',,e... .. .. } + .✓!s .. ....,. ., �n�r.: ... � ,2�.-K^. .,,,. to ...: i 3
<br /> Existing Use of Building: Contract Price of Work:$5500
<br /> Proposed Use of Building: Heat Source: DGas DElectric DOther
<br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure
<br /> Type of Project: ❑New ❑Addition ©Remodel ❑✓Repair DTA. ❑Sign ESprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> GAS INSERT INSTALLATION
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECO_ N OA ALERMIT .1PPLJCA'TXOt P0 „1140-1010111, .0 .....: Her
<br /> FixtureFlxrare 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 /> i Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> hSEY
<br /> __ , ,�,_,�,, `,,,,_, „_ _�� ;� �„ ,, � �1t Sewage Ejector or Sump Pump Other:
<br /> Water Suppression SystemNo.of Heads
<br /> Chemical Suppression System I 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 /> � �, / , ,J �J ) City of Everett Official Use Only
<br /> / /e/ .G.,44 4 i'/ /l/C PERMIT#�/� \ Olt
<br /> 11/21/19 I�(�,/�1 (/ ` Olt
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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