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M PERMIT APPLICATION• <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1430 West Casino Road # 52 PROPERTY TAX#: 00865700505200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Daniel Gardner TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1430 W Casino Road #52 <br /> CITY Everett STATE WA ZIP 98042 <br /> OWNER PHONE: 425-265-7547 OWNER EMAIL: Gard nerDaniel@Yahoo.Com <br /> CONTRACTOR NAME: Olympic Mechanical, Inc. <br /> CONTRACTOR ADDRESS: STREET 21718 66th Ave W Suite#207 <br /> CITY Mountlake Terrace STATE WA zIP 98043 <br /> CONTRACTOR PHONE: 425-774-8841 CONTRACTOR EMAIL: John@OlympicMechanical.com <br /> CONTRACTOR LICENSE#(REQUIRED): OLYMPM117001 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):019260 <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: John MacDonald CONTACT PHONE: 425-774-8841 <br /> CONTACT EMAIL: John@OlympicMechanical.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Res Contract Price of Work:$ 2,824 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex []Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition []Remodel ❑Repair ❑T.I. ❑Sin ❑S rinkler []Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace Furnace and Hot Water tank"Like for Like" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration X Repair Type of Project: _New _Addn _Alteration X Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of 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 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 Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water I I No.of Heads <br /> ACKNOWLEDGEMENT I haver viewed 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 la 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 au ofized 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 C ntractors Law 18.27 RCW and 296.200A WAC. <br /> X City of Everett Official Use Only <br /> i <br /> PERMIT# <br /> O er Auth rized Agent Signature Date (Revised 9/23/2016) <br />