Laserfiche WebLink
• <br /> PERMIT APPLICATION <br /> /4 ?I''� BUILDING / MECHANICAL I PLUMBING I SIGN 1 SPRINKLER/ DEMOLITION <br /> 1ill - - 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 1 www.everettwa.gov/permits <br /> (Blua or Black Ink Only PIo) 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 /> cnY EVERETT STALE WA ZIP 98204 <br /> OWNER PHONE: 425-348-6930 OWNER EMAIL:fgC2emc@frontier.cOm <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY ,w, <br /> CITY EVERETT STATE WA zip 98201 <br /> PONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM '— <br /> ,— <br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI*09554 CITY OF EVERETT BUSINESS UCENSE#(REQUIRED). -016O98, <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) -., <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> `KA)LANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> EXisting Use of Building: Contract Price of Work: 10750 <br /> IA . <br /> Proposed Use of Building: Heat Source: OGas DElectric ©Other <br /> WILDING USE: DSFR OTownhouse ODuplex DADU OMu1ti.Family-#Units: OCommercial OAccessoryStructure <br /> yype;of Project: ENew ®Addition IZiRemodel ©Repair OT.I. OSign OSprinkler EJDemoiition OChange of Use <br /> ESCRIPTION OF WORK: <br /> ~ <br /> I4IKE IN KIND GAS FURNACE CHANGE OUT WITH HEAT PUMP INSTALLATION <br /> p„ <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> t <br /> y <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count 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 /> i- Boller Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)' <br /> r-- Clothes Dryer i Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) - - <br /> i " 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 /> r Exhaust Hood(Typal!) Water Heater Interceptor-Grease Waste/Water Piping Repair_ _-- -- <br /> r Exhaust Hood(Residential), Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> i Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> F Gas Fireplace/Insert/Log I Roof Drains Water Heater <br /> ,;' SPRINKLER`/SUPPRESSION SYSTEM - 'Sewage Ejector or Sump Pump Other: <br /> (dater Suppression System No.ofHeaas <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 i <br /> Building Official before being authorized under any circumstance.i am the owner,or 1 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 298.200A WAC. <br /> City of Everett Official Use Only <br /> FERMI # <br /> , '�p ,�% 2A J ,/ti J 12/06/19 ilk, S 2 - <br /> o <br /> Y L Y <br /> OwnerlAuthorized Agent Signature f' Date (Revised 0/0/2018) <br />