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411 • <br /> PERMIT APPLICATION <br /> 74 <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> 'II IP°„oval' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)overettepsieverettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2107 HOYT AVE PROPERTY TAX#:00437043400300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TOM STIGER TENANT BUSINESS NAME(Commercial); <br /> OWNER MAILING ADDRESS: STREET PO BOX 811 <br /> or( EVERETT STATE WA ZIP 98206 <br /> OWNER PHONE: 425-350-4289 OWNER EMAIL:tomstiger@baysidefloorsupply.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> cry EVERETT STATE WA zip 98201 <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED);CMHEAI*09554 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 01609,8 <br /> PRIMARY CONTACT: ❑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:$4500 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial EAccessory Structure <br /> Type of Project: Q]New ClAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> 'DESCRIPTION OF WORK: <br /> SINGLE ZONE DUCTLESS INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial 3-com( p,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 /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.oHeads <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 I <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, 1 <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> i <br /> City of Everett Official Use Only --- <br /> RA <br /> (.L.4 .c Y Yy /t✓ 11/18/19 PEW" #��' ‘ - L PLC 2 <br /> Owner/Authorized Agent Signature Date (Revised 10/10r2018) <br /> a <br /> i{{{{t <br />