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El <br />0 PERMIT APPLICATION 0 <br />BUILDING / 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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink On1 Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 5323 NARBECK AVE <br />PROPERTY TAX #: 00897000001100 <br />LEGAL for new construction: Short Plat/subdivision Lot No (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: HEIDI SCHOEFFLING TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 5323 NARBECK AVE <br />c,Ty EVERETT STATE WA zip 98203 <br />OWNER PHONE: 360-672-9161 <br />OWNER EMAIL: UPEOPLE2@COMCAST.NET <br />CONTRACTOR NAME: C.M. HEATING INC <br />CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br />C,Ty EVERETT STATE WA ziP 98201 <br />CONTRACTOR PHONE:425-259-0550 <br />CONTRACTOR EMAIL: KAILANA@CMHEATING.COM <br />CONTRACTOR LICENSE #(REQUIRED): CMHEAI*09554 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 016098 <br />PRIMARY CONTACT: [DOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />KAILANA <br />CONTACT PHONE:425-259-0550 <br />CONTACT EMAIL: KAILANA@CMHEATING.COM <br />BU I LDING;,:INFORMATI ON <br />Existing Use of Building: Contract Price of Work: $ 3500 <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE ❑SFR ::]Townhouse ::]Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ElAccessory, Structure <br />Type of Project: ❑New ❑Addition F Remodel L✓IRepair LT. 1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />LIKE IN KIND GAS FURNACE CHANGE OUT <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C —Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I <br />I No. of Heads <br />Chemical Suppression System <br />I <br />INo. 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 />Owner/Authorized Agent Signature <br />City of Everett Official Use Only <br />PERMIT # <br />10/03/19 C) C) <br />)ate (Revised 10/10/2018) <br />