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• • <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> ...4a 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 vwrw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1716 96TH ST SW PROPERTY TAX#:00947000001100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: RODNEY CHELIUS TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1716 96TH ST SW <br /> cir EVERETT STA1E WA ZIP 98204 <br /> OWNER PHONE: 425-348-6930 OWNER EMAIL:rgc2emc@frontier.com <br /> .. ................. <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#REDUIRED):CMHEAI*09554 <br /> { CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): -01609$„ <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) . <br /> .4.i <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAILANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> a <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$t075° "• <br /> Proposed Use of Building: Heat Source: Gas DElectric ©Other - <br /> k , <br /> BUILDING USE: DSFR Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ECommercial ❑Accessory Structure <br /> Type of Project: EZNew ZAddition ©Remodel ©Repair DTI. ESign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ‘LIKE IN KIND GAS FURNACE CHANGE OUT WITH HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 4 <br /> t Fixture Fixture Fixture <br /> List of Fixtures 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 /> — <br /> + Boller 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 /> k i Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log _ Roof Drains Water Heater <br /> ` SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> /ater Suppression System I 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 /> lcurrent federal,slate,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 1 <br /> tBuilding Official before being authorized under any circumstance.I am the owner,or I ant 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 16.27 RCW and 296.200A WAG. <br /> City of Everett Official Use Only <br /> v PERMI # <br /> , ,4, 12/oeiie At 2 - 3 2 <br /> Owner/Authorized Agent Signature 6 Date (Revised 1O/10t20f8) <br />