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BIM • • <br /> 1116111 PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN/SPRINKLER!DEMOLITION <br /> E V E R E T T CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASMI lrsTON (P)425-257-8810 i FAX 425-257-8857 i(E)everetteps@everettvwa.gov 1 www.everettwa.govlpermifs <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:4409 Ridgemont Dr. PROPERTY TAX#:00555600000400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Melanie Throckmorton TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET4409 Ridgemont Dr. <br /> cn- Everett STATE WA zap 98203 <br /> OWNER PHONE:425-750-3139 OWNER EMAIL:2010meljt@gmail.COm <br /> CONTRACTOR NAME:Clean Air Comfort Systems <br /> CONTRACTOR ADDRESS: STREET 102 Grover St. #205 <br /> cm Lynden <br /> STATE WA zyp 98264 <br /> CONTRACTOR PHONE:360-398-9400 CONTRACTOR EMAIL:SerViCe@CleanairCOmfOrtSyStom <br /> CONTRACTOR LICENSE#(REc UIRED):CLEANAC85I MG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): gt '") <br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-750-3139 <br /> Melanie Throckmorton CONTACT EMAIL:201omeljjt@gmail.com <br /> BUILDING INFORMATIO <br /> N <br /> N <br /> Existing Use of Building:Residential Contract Price of Work:$6244.54 _ <br /> Proposed Use of Building: Heat Source: ['Gas ❑Electric DOther <br /> BUILDING USE: DSFR ['Townhouse LiDuplex UAW DMulti-Family-#Units: ['Commercial IDAccessory Structure <br /> Type of Project: [New DAddition ['Remodel ©Repair DT.I. ['Sign ['Sprinkler ODernolition DChange of Use <br /> DESCRIPTION OF WORK: Replace like in kind water heater and NG furnace. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture <br /> Count �riur List of Fixtures Fixture List of Fixtures List of Fixtures <br /> Count Count <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-comp,prep,fioor) <br /> Clothes Dryer 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) 1 Water Heater Interceptor-Grease Waste/V/ater Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> '1 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 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 /> 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.lam the owner,or 1 am 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> C? ' ,/ .-------------- /3 1)q ficl 'WV L'A 2 -0(0(0 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />