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110 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER I DEMOLITION <br /> EVERETT CITY.OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps@everettwa:gov I www:everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESs:240 ALVERSON.BLVD PROPERTY TAX#00507500002100 <br /> LEGAL for new construction: Short Plat/subdivision MARINE PARK Lot No.21 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: RICK ALLEN TENANT BUSINESS NAME(commercial):. <br /> OWNER MAILING ADDRESS: STREET 240 ALVERSON BLVD <br /> ciTr EVERETT STATE WA ziP 98201 <br /> OWNER PHONE: 425-754-5100 OWNER EMAIL: RICKALLEN5100@GMAIL.COM <br /> CONTRACTOR NAME.:EVERGREEN STATE HEAT&AC <br /> CONTRACTOR ADDRESS: STREET 2120 PACIFIC AVE <br /> ciTv EVERETT STATE WA zlp 98201 <br /> CONTRACTOR PHONE:425-252-3114 CONTRACTOR EMAIL:LESLJE@ESSMWA.COM <br /> CONTRACTOR LICENSE#(REQUIRED): EVERGSS022OT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 007955 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-252 3114 <br /> LESLIE CHAPMAN CONTACT EMAIL: LESLIE@ESSMWA.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building:SINGLE FAMILY Contract Price of Work:$17600 <br /> Proposed Use of Building: Heat Source: OGas DElectric 0Qther0lL FURNACE <br /> BUILDING USE: EISFR OTownhouse DDuplex ❑ADO ClMulti-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ONew DAddition DRemodel O✓Repair DT.I. DSign OSprinkler DDernolition DChange of Use <br /> DESCRIPTION OF WORK: REMOVE OIL FURNACE AND INSTALL.ELECTRIC AIR HANDLER WITH STRIP HEAT BACKUP <br /> AND HIGH EFFICIENCY OUTDOOR HEAT PUMP <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Count Count 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,floor) <br /> Clothes Dryer 1 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 HeatfAC 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 /> 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 No.of Heads <br /> Chemical Suppression System I No.of Heads <br /> ACKNOWLEDGEMENT:I 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,stale,and focal 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 era authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Slate Contractors Law 18.27 RCW and 296200A WAC <br /> City ofEverett Official Use Only <br /> 5 1/11 PERM,.. 10 05 <br /> owner/Authorized Agent Sign re Date (Revised d 10/20 8) <br />