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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> ,4" Z677- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � 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:1327 MADRONA AVE PROPERTY TAX#:00505700003402 <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: MICHELLE PARKER TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1327 MADRONA AVE <br /> ciTY EVERETT STATE WA zip 98203 <br /> OWNER PHONE: 425-210-7003 OWNER EMAIL:lanrparker@msn.com <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> ,,Ty EVERETT STATE WA Zip 98201 <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAILANA@CMHEATING.COM <br /> CONTRACTOR LICENSE#(REQUIRED):CMHEAI"09554 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 016098 <br /> PRIMARY CONTACT: ❑OWNER I]CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAILANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$9000 <br /> Proposed Use of Building: Heat Source: ❑Gas ElElectric ❑Other <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Famil -#Units: ❑Commercial []Accessory Structure <br /> .Type of Project: ✓❑New ✓❑Addition >r]Remodel ZRe air OT.I. ❑Sin ❑Sprinkler []Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> LIKE IN KIND AIR HANDLER CHANGE OUT WITH HEAT PUMP INSTALLATION <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures FIxturo Fixture Fixture <br /> Count count List of Fixtures Count List of Fixtures Count List of Fixtures <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-com( p,prep,floor) <br /> Clothes Dryer Heat PumpBDuctless 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 1) (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 /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.o eads <br /> Chemical Suppression System No.of Heads <br /> I ACKNOWLEDGEMENT..'I have reviewed this applicalion and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> 3currenl federal,stale,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 /> iBudding 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAG. <br /> City of Everett Official Use Only j <br /> PERMI t� <br /> 10l29/19 � <br /> Owner/Authorized Agent Signature Date (Revised 1011012018), <br /> 1 <br />