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PERMIT APPLICATION <br /> "IIIIP' <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everettepS@everettwa.gov everettwa.gov I www.everetlwa.gov/permits <br /> v(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:4807 SEAHURST AVEPROPERTY TAX#:29043600308700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No.___ (attach copy of long legal description) <br /> CONTACT INFORMATION' <br /> OWNER NAME: NICK ANSPACH TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET4807 SEAHURST AVE <br /> CITY EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: 425-770-4893 OWNER EMAIL:n_anspach@hotrlmail.conm <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 B ROADWAY <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): 01609U <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $11750 <br /> Proposed Use of Building: •Heat Source: Gas ❑D Electric DOther g <br /> )BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial LWIAccessory Structure I <br /> Type of Project: New ❑✓Addition ❑✓Remodel ORepair ❑TI. ❑Sigrt USprinkler ❑Demolition ❑Change,of Use <br /> DESCRIPTION OF WORK: <br /> ,.LIKE IN KIND GAS FURNACE CHANGE OUT WITH NC INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> I 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 /> i 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,fioor) <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 /> ETM Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> it 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 /> i 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Oily of Everett Official Use Only <br /> J'le"YC� vrt/,t`7 7111-04,24PERMIT, �� Il�� 0 iq <br /> 09/23/15 <br /> [Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br /> e e <br />