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• • <br /> PERMIT APPLICATION <br /> eir.:74. BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 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( www.everettwa.govipermtts <br /> (Um or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:4733 GLENWOOD AVE PROPERTY TAX#:00505700004804 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT I N Fi IMATION <br /> OWNER NAME: BRAD SWAFFARD TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET4733 GLENWOOD AVE <br /> cm( EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: 425-359-5121 OWNER EMAIL:Swafards@comcast.net <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> cirr EVERETT STATE WA zip 98201 <br /> CONTRACTOR PHONE:425-259-0550 1CONTRACTOR EMAIL:KAILANA@CMHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI*09554 CITY'OF EVERETT BUSINESS LICENSEI!(REQUiRE0): 016098: <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: JCONTACT PHONE:425-259-0550 <br /> KAILANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$5000 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric £30ther <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New ©Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: A/C INSTALLATION <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALRRMIT APPCATION PLUMBERMIT AP .,,LICATION - <br /> Fxture Fixture Fixture Fixture <br /> Count List of Fixtures Count Count of Fixtures Count List of Fixtures Count List of Fixtures �...', <br /> i NC-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 _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 Ventilatlor 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 /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> I <br /> SPRIINKLBR I SUPl ,: `, " <br /> ,,SYSTEM. Sewage Ejector or Sump Pump _ Other: <br /> Water Suppression System 1 o.°Meads <br /> Chemical Suppression System f No.or 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> F City of Everett Official Use Only <br /> t ,,/f�/ r} 7,��/^�` PERMIT#1 <br /> V. -44. cY Ir/(O/ 05/17/19 i\R ` `C nL <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br /> e j. <br />