4627 21ST DR W 2020-02-24 - Laserfiche WebLink

PERMIT APPLICATION lifilPBUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION A4,410,�'' CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Ski,or Block Ink Only Plow* PROJECT SITE INFORMATION , PROJECT SITE ADDRESS:4627 21ST DR W PROPERTY TAX#:00895600000100 LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: CAROL TESCHOW TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 4627 21ST DR W ci-- EVERETT STATE WA zip 98203 OWNER PHONE: 425-770-0606 OWNER EMAIL:carol.telschow@gmail.com CONTRACTOR NAME:C.M. HEATING INC CONTRACTOR ADDRESS: STREET 1415 BROADWAY cin EVERETTSTATE WA ZIP 98201 ' CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING,COM CONTRACTOR LICENSE#(REQUIRED):CMHEAI"09554 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 016098 PRIMARY CONTACT: El OWNER O CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-259-0550 KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$11,00o Proposed Use of Building: Heat Source: OGas IiiElectric ❑Other BUILDING USE: IDSFR ❑Townhouse ❑Duplex EADU ❑Multi-Famiy-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New R1Addition ❑Remodel EJRepair ❑T.I ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: LIKE IN KIND FURNACE CHANGE OUT WITH A/C INSTALLLATION ;ASSOCIATED BUILDING PERMIT#(it applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION I Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures ..h I NC–Air Handling Units — Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) _ 1 Forced Air Systems Other Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM' Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System FNo.of Heads 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 I 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 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, and I comply with the State Contractors Law 18.27 RCW and 296,200A WAC. / 1(y) City of Everett Official Use Only Cy /t/1 f 49 08/09/19 PERMIT \,,/� D 093 Owner/Authorized Agent Signature Date (Revised 10001201 8) 1 i