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• i► <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING t SIGN t SPRINKLER I 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.everettwa.govlpermits <br /> BBlua or Block Ink Only P!onso) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1911 17TH ST PROPERTY TAX#:00438233701701 <br /> LEGAL for new construction Short Plat/subdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION • <br /> OWNER NAME: RYAN RICHARDSON TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1911 17TH ST <br /> cn-y EVERETT STATE WA zip 98201 <br /> OWNER PHONE: 425-417-2902 OWNER EMAIL:rkrichardson1984@gmail.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> cm 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): 0160982J' <br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAI LANA CONTACT EMAIL:KAILANA©CMHEATING.COM <br /> t BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$9000 <br /> Proposed Use of Building: Heat Source: ❑Gas ElElectric DOther <br /> BUILDING USE: MSFR ❑Townhouse ❑Duplex EADU ElMulti-Family-#Units: ❑Commercial EAccessory Structure <br /> Type of Project; ZNew ❑✓Addition ❑✓Remodel ZRepa r an, ESisn ❑Sprinkler ❑Demolition ❑Change of Use .. <br /> DESCRIPTION OF WORK: <br /> ;LIKE iN KIND AIR HANDLER CHANGE OUT WITH HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture_ Fixture <br /> Count List of Fixtures coupe 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 =. Heat Pump&Ductless Dishwasher Sink-Residential(kitchenbath,bar) <br /> } <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 /> q <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 /> A I Forced Air Systems V Other: r Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> k SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> l laterSuppressron System `Flo.o#Tleads <br /> - <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 /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and i comply with the State Contractors Law 18,27 RCW and 296.200A WAD <br /> F„ <br /> City of Everett Official Use Only <br /> (� ,�r// �(� f , J PERMI # J(�) <br /> r lam/ V/ -.eY4 l�i /1 10/10/19 �" r n <br /> Owner/Authorized Agent Signature ,! Date (Revised W/10/2018) <br /> t <br />