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0 <br />PERMIT APPLICATION <br />BUILDING I MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov everettwa.gov I www.everettwa.gov/perrnits <br />BIu+► or Black Ink Ont <br />ly Plo so PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1330 HOYT AVE <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) J <br />CONTACT INFORMATION <br />OWNER NAME: JERRY SLIDER TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 1330 HOYT AVE <br />cirr EVERETT STATE WA zip 98201 <br />OWNER PHONE: 206-601-6895 77fO;NER <br />EMAIL: <br />CONTRACTOR NAME: C.M. HEATING INC <br />CONTRACTOR ADDRESS. STREET 1415 BROADWAY <br />c,, EVERETT STATE WA zia 98201 <br />CONTRACTOR PHONE: 425-259-0550 CONTRACTOR EMAIL: DEBBIE@CMHEATING.COM <br />CONTRACTOR LICENSE O(REQUIRED) : CMHEAI*09554 <br />CiTY OF EVERETT BUSINESS LICENSE #(REQUIRED): 0160981 <br />PRIMARY CONTACT: ❑ OWNER El CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />DEBBIE <br />CONTACT PHONE: 425-259-0550 <br />CONTACT EMAIL: DEBBIE@CMHEATING.COM <br />t <br />BUILDING INFORMATION <br />Existing Use of Building: SFR <br />Contract Price of Work: $ 4550 <br />Pro osed Use of Building: <br />Heat Source: I]Gas ❑Electric ❑tither <br />BUILDING USE: [DSFR ❑Townhouse :]Duplex ❑ADU ❑Multi -Family- # Units: ❑Commercial ElAccessory Structure <br />Type of Pro ect: ❑New ❑Addition []Remodel JIRe air ❑T.1, ❑Sin US rinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: REPLACE GAS FURNACE <br />f` <br />SSOCiATED BUILDING PERMIT # (if a iicable), <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Future <br />Count <br />List of Fixtures <br />Pxlura <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C —Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside 131d) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,fioor) <br />Clothes D er <br />Heat PumpBDuctless <br />Dishwasher <br />Sink -Residential (kitchen.bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinkin2 Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not HeaVAC system) <br />IFloor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />interceptor-Sand/011 <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/InserULog <br />Roof Drains <br />I <br />lWater Heater <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other <br />water Suppression System <br />o. of Peads <br />hemicai Suppression SystemI <br />INo, 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 property to perform the work for which application is made, <br />and / comply with the State Contractors Law TO 27 RCW and 296.200A WAC. I <br />City of Everett Official Use Only <br />PERM T # <br />O a� <br />Ow er/,4uthorized Age signature Date (Revised 10110120f8) <br />