4106 CLIFF DR 2019-01-25 - Laserfiche WebLink

PERMIT APPLICATION BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue ur=Blaak•:Ink Onl Pleas, PROJECT SITEINFORMATIONPROJECT SITE ADDRESS: L( (A9f j�(f f f, PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: barry herem TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4106 cliff dr CITY everett STATE wa ZIP 98203 OWNER PHONE: OWNER EMAIL: barryherem@gmail.com CONTRACTOR NAME: AXIOM HVAC CONTRACTOR ADDRESS: STREET 2232 broadway CITY everett STATE wa ZIP 98201 CONTRACTOR PHONE: 425-512-9689 CONTRACTOR EMAIL: daron@axiomnw.com CONTRACTOR LICENSE#(REQUIRED): AXIOM1892RM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54279 • PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425 879 5351 Daron Smith CONTACT EMAIL: daron@axiomnw.com BUILDING;PERMIT APPLICATION Existing Use of Building: sfr Contract Price of Work:$ 4600 Proposed Use of Building: Heat Source: ❑Gas DElectric ERIOther Building Type: E ISFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial Type of Project: El New ❑Addition ❑Remodel ❑Repair I T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: install ductless heat pump ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATIONPLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures 1 A/C—Air Handling Units .1 Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER',/SUPPRESSION'SYSTEM': Chemical or Water ' !No.of Heads 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 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 Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply ' the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only aO �2�� PERMITn16_ JJ ` '1(n/ 0 er/Authorized Agent Signature Date (Revised 9/23/2016)