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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> "Illid:41 CITY OF EVERETT PERMIT SERVICES , <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-8810 I 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:2227 GRAND AVE PROPERTY TAX#:00439148201400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 4 <br /> CONTACT INFORMATION <br /> OWNER NAME: MELISSA DILTZ TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET2227 GRAND AVE <br /> cry EVERETT STATE WA ZIP 9820 <br /> TOWNER PHONE: 206-406-2707 OWNER EMAIL:ROOKMEL@GMAIL.COM <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> EVERETT WA 98201 ''- <br /> CITY STATE ZIP <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: 0 OWNER ID CONTRACTOR 0 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. $13200 <br /> Proposed Use of Building: Heat Source: ❑Gas MElectric ❑Other <br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. ❑Sjn ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 2 ZONE HEAT PUMP SYSTEM INSTALL, ONE ZONE DUCTLESS, THE OTHER DUCTED <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures coupe List of Fixtures Count List of Fixtures Count List of Fixtures <br /> - <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-comp,prep,floor) <br /> Clothes Dryer i 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 Ventilation 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 /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.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 /> PERj ,a C 2_ OA <br /> /jN/C /Len/t,4 i0,0/!1 02/14/19 ` <br /> Owner/Authorized Agent Signature Date (Revised 10f102016) <br /> ( <br />