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410 • <br /> j#1011101. 4 . <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa,gov I www.evercttwa.gov/permits <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:6922 LOWER RIDGE RD PROPERTY TAX#:00392000003401 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: INA JOHNSON TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET6922 LOWER RIDGE RD <br /> crry EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: 206-851-7378 OWNER EMAIL:inaj1263@gmail.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> cONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> ciry EVERETT STATE WA z,P 98201 ` ... <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI*09554 CITY OF EVERETT BUSINESS LICENSE ll(REQUIRED): 016098 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑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: $13500 <br /> Proposed Use of Building: Heat Source: ❑Gas 0Electric ❑Other <br /> BUILDING USE: DSFR ETownhouse ❑Duplex ❑ADU ( iMulti-Family-#Units: ❑Commercial EAccessory Structure <br /> Type of Project: ZNew ©Addition [21Remodel ©Repair ❑T.I. ❑Sign USprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: LIKE IN KIND AIR HANDLER CHANGE OUT WITH HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> it <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count Count List of Fixtures Count List of Fixtures Count List of Fixtures „,, <br /> NC—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 i 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 Ventilation 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 /> t Forced Air Systems _ Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> o" SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 /> t3uiiding Official bet e being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made <br /> end I comply wifh a State Contractors Law 18,27 RCW and 296.200A WAC.. i <br /> { City of Everett Official Use Only <br /> . <br /> '� i P 11T#'t 12H 0/19 t <br /> 4wnertAuthorizedArTnt tignature Date (Revised 10/10 D18) <br /> _n 1d ) <br /> t t <br />