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PERMIT APPLICATION <br /> r,�'"" 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( www.everettwa.gov/permits <br /> w(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SiTE ADDRESS:4503 RIVERFRONT BLVD PROPERTY TAX#:01167800003000 <br /> LEGAL for new construction: Short PlatJsubdiviSion , ,Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: DREW JOHNSTON TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET4503 RIVERFRONT BLVD <br /> err EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: 425-478-7520 OWNER EMAIL:Joanneamack@gmail.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> CITY 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 O CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> w <br /> Existing Use of Building: Contract Price of Work:$7000.00 <br /> M <br /> Proposed Use of Building Heat Source: OGas Electric ❑Other_ <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units ❑Commercial ❑Accessory Structure <br /> Type of Project' ❑New ❑✓Addition ❑Remodel LiRepair ❑T.I. ESign ❑Sprinkler EDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: A/C INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 List of Fixtures <br /> 1 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,piep,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 Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease WastefWater 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/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 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 /> j ( J 05115/19 �O City of Everett Official Use Only <br /> C <br /> / Y( IL /t94 PEmV C) —W5 <br /> Owner/Authorized Agent Signature Date W (Revised 10601201&) <br />