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PERMIT APPLICATION <br /> 000: .. <br /> BUILDING I MECHANICAL / PLUMBING /SIGN l SPRINKLER / DEMOLITION <br /> 4� CITY OF EVERETT PERMIT SERVICES <br /> ,4.410 3200 CEDAR STREET,EVERETT.WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2302 RAINIER AVE PROPERTY TAX#:00401649603100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: JASON VIVEIROS TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 2302 RAINIER AVE <br /> crry EVERETT STATE WA ZIP 98201 <br /> OWNER PHONE: 425-299-2906 OWNER EMAIL:jgiffordv@gmail.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY -- <br /> cm, EVERETT STATE WA zia 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: 0 OWNER 0 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: $19000 <br /> Proposed Use of Building: Heat Source: ElGas DElectric Other <br /> BUILDING USE: Dv-SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units:_____,,___ ❑Commercial ❑Accesso Structure <br /> Type of Project: ❑New II1Addition ®Remodel ❑✓Repair ❑T.I. USign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ;LIKE IN KIND GAS FURNACE CHANGE OUT WITH HEAT PUMP INSTALLATION . <br /> ASSOCiATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Gounr Gaunt 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 1 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 /> 1 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 /> ACItNOWLEDGEMENT 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 <br /> WACCity of Everett Official Use Only <br /> y <br /> PERMIT# alIr (tf /L/JJ.4 1 'L0��ti� 11/11!19 fl l- C \/ <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />