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M] <br />0 PERMIT APPLICATIA <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 Only Phase) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 6328 BERKSHIRE DR <br />PROPERTY TAX #: 00392900603700 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ANDY BROWN TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET6328 BERKSHIRE DR <br />crTY EVERETT STATE WA zip 98203 <br />OWNER PHONE: 206-818-6549 <br />OWNER EMAIL: brown.andrew.robert@gmail.com <br />CONTRACTOR NAME: C.M. HEATING INC <br />CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br />cin, 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: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />KAILANA <br />CONTACT PHONE:425-259-0550 <br />CONTACT EMAIL: KAILANA@CMHEAT[NG.COM <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ 5750 <br />Proposed Use of Building: <br />Heat Source: E]Gas []Electric ❑Other <br />BUILDING USE ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family- # Units: ❑Commercial ElAccessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel L_IRepair LIT. 1. ❑Sin ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: <br />GAS INSERT INSTALLATION WITH NEW GAS LINE TO INSERT <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 />Future <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 />1 <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 Ventilator <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <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 />i <br />IGas Fireplace/Insert/Log <br />I <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. 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 />11/05/19 <br />orized Agent Signature v Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 1011012018) <br />