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PERMIT APPLICATION <br /> ilifiV 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 I(E):evsretteps( everettwagov l www.everettkva.gov/pernits <br /> a J N <br /> �: CT DIT 1 u. �R j► <br /> ...........: <br /> PROJECT SITEADDRESS:4815 ELM ST PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 4 CONTACT U4 RRIY'1! ON 4,' ,` <br /> OWNER NAME: KAREN KLAMM TENANT BUSINESS_NAME(Commercial): <br /> m. <br /> •WNER MAILING ADDRESS: STREET4815 ELM ST <br /> crr ,EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: 425-252-6515 JOVINER EMAIL.ksklamm@yahoo.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> - a <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY '-- <br /> cmr EVERETTSTATE WA zip 98201 <br /> ONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:DEBBIE@CMHEATING.COM <br /> ONTRACTOR LICENSE#(REQUIRED):CMHEAI*09554 ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 016095;, <br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> DEBBIE CONTACT EMAIL:DEBBIE@CMHEATING.COM .,-, <br /> BUILDING INPORMATItNi1 .., <br /> Existing1858.00 Use of Building: Contract Price of Work:$ <br /> Pro•osed Use of Buildin r' Heat Source: DGas DElectric ❑Other -- <br /> WILDING USE I SFR DTownhouseCIDuttex ❑ADU ❑Mufti-FamItt-#Units: ❑Commercial sort'Structure <br /> Type of Project ,- <br /> r-i‘ ❑Addition Rerrt ®Rep&Ir' DT.I, DSrgn ,:,❑Sprinkler DDemolition ❑.Gltange of;Usp <br /> DE.aC�TiQN OF WORK: REPLACE GAS WATER HEATER <br /> ASSOCIATED BUILDING PERMIT#(if aPplitablt ., <br /> ` MECHANICAL PERMIT APPLiCATItON ,w:f PLtoretts INGtos MIT,APPLICATION <br /> "Fixture !r Fixture Fixture Fixture <br /> „Count List of Fixtures count List of Fixtures count count of Fixtures List of Fixtures ... <br /> NC-Air Handling Units - Gas Piping Backflow Prevenfer(Inside Bldg) Shower,,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial 3-com•,pre•,floor] . <br /> Clothes Dryer Heat Pump&Ductless.. Dishwasher Sink-Residential(kitchen,bath,bar), 'M. <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop „ . <br /> Exhaust Fans(Residential Commercial Ventilatio Floor Drain Toilet <br /> Exhaust Hood(Type I) ,(Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type ll) 1 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 -i,, <br /> Gas Fireplace/Insert/Log, Roof Drains Water Heater " ; <br /> SPRINKLER I SUPPRESSION SYSTEM.: Sewage Ejector or Sump Pump Other: <br /> I r .. . - 'Flo.ofHeajs , . <br /> ,i0f:8uppression System No.of Heads <br /> 4ClcNOVW-EDt�wr 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 /> dinTelttfederal,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 /> }au 1dfng Official before being authorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the work for which application is made <br /> `and f comply with the State Contractors Law 18.27 RCW and 296,200A WAC. <br /> CIO of Everett_Official Use Only <br /> PERM T.# <br /> Debbie Bauers oa ',10.2,.asyawm.e••.1 \ <br /> r <br /> Owner/Authorized Agent Signature Date (Re" ' 1Gi/1020fe) <br />