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BUILDING ECHANICAL I PLUMBING CSIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,44 ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4712 Baker Dr PROPERTY TAX 417400001700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Charles Newcombe TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4712 Baker Dr <br /> aTv Everett STATE WA zip 98203 <br /> OWNER PHONE: (425)356-9132 OWNER EMAIL: <br /> CONTRACTOR NAME: NW Mechanical <br /> CONTRACTOR ADDRESS: STREET 3204 NE 145th St <br /> erre $horeline STATE WA ZIP 98155 <br /> CONTRACTOR PHONE: (206)267-4328 CONTRACTOR EMAIL: Kasey@nwmechanical.com <br /> CONTRACTOR LICENSE#(REQUIRED): NORTHMI151MJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 034775 <br /> PRIMARY CONTACT: 0 OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Kasey Galash CONTACT PHONE: (206)267-4328 <br /> CONTACT EMAIL: Kasey@nwmechanical.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Residence Contract Price of Work:$ 13,469.00 <br /> Proposed Use of Building: Heat Source: CiaGas DElectric DOther <br /> Building Type: ®SFR-Detached ❑SFR-Attached ©Duplex DMulti-Family-#of Units: ❑Commercial El Industrial <br /> T pe of Project: ONew DAddition DRemodel DRepair ❑T.l. ❑Si•n ❑Sprinkler ❑Demolition ❑Chane of Use <br /> DESCRIPTION OF WORK: Replace existing boiler with new Viessmann Vitodens 200 95%efficient 125,000 BTUH wall mounted condensing <br /> gas boiler. Model#B2HB-35. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL. PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration _Repair Type of Project: _New _Addn Alteration Repair <br /> #of #of ` #'pf 'Y #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump `` Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems"'` Unit Heater Bathtub Urinal <br /> Gas Piping 1 Boiler Lavatory(Wash Basin)' Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Drier Hookups Other: Clothes Washer Medical Gas <br /> Range Hood' Water Heater Other: <br /> Exhaust Fan Sink(Sevice/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> *Please call Kasey at NW Mechanical for payment* PERMIT <br /> 2/19/16 <br /> IU62. - <br /> Owner/Authorized Agent Signature Date " (Revised 10/12/2015) <br />