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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />4Z77 CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everettepsAevetettwa.ctov I www.everettwa.00v/permits <br />(blue or Black Ink On Pl 6PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 302 77TH PL SW <br />PROPERTY TAX #: 00389600001000 <br />LEGAL for.new:.Construction:._.Skit,rt.PlaUsubdivisian ... Lol: No.. (attach coley of -long legal.descriptaon)......... <br />CONTACT INFORMATION <br />OWNER NAME: KEN DAHLMAN TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET302 77TH PL SW <br />c!Tv EVERETT STATE WA z!P 98203 <br />OWNER PHONE: 425-330-4525 OWNER EMAIL: kdahlman20l8@gmail.com <br />CONTRACTOR NAME: C.M. HEATING INC <br />CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br />,,Ty EVERETT STATE WA Z!P 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: ❑ OWNER EI CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />KAILANA <br />CONTACT PHONE:425-259-0550 <br />CONTACT EMAIL: KAILANA@CMHEATING.COM <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ 6750 <br />Proposed Use of Buildin <br />Heat Source: ❑Gas QElectric ❑Other <br />BUILDING USE: IZISFR ❑Townhouse ❑Du lex ❑ADU ❑Multi -Family- # Units: ❑Commercial []Accessory Structure <br />Type of Pro ect: ❑New ©Addition ❑✓ Remodel ❑✓ Re air ❑T1 f lSl n ❑S rinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: <br />2 ZONE DUCTLESS HEAT PUMP INSTALLATION <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 />Fixturo <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixfure <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 Ventilation <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type I <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type II) <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/Inser /Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression gystem <br />No of eads <br />Chemical Suppression System I <br />I <br />No. of Heads <br />ACKNOWLEDGEMENT. / 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 or 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. l am the owner, or 1 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 VVAC. <br />......... <br />IFYC�.L.�Y/VRY /lli�� 01/21/20 <br />Owner/Authorized Agent Signature 6V Date <br />City of Everett Official Use Only <br />PER #e - <br />(Revised 10/10/2016) <br />