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PERMIT APPLICATION <br /> BUILDING i ECHANICAL/ PLUMBING/SIGN /S INKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov J www.everettwa gov/permits <br /> -e <br /> (Blue or Black Ink Only Please) <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:5031 HARBOR LANE PROPERTY TAX#:00732800000600 <br /> LEGAL for new construction: Short katitubdtViston Lot,No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> ... ... <br /> OWNER NAME: LAURIE CARLSON TENANT BUSINESS NAME(Commercial). <br /> OWNER MAILING ADDRESS: STREET 5031 HARBOR LANE <br /> carr EVERETT STATE WA ZIP 98203 <br /> OWNER PHONE: 425-231-9788 OWNER EMAIL.LAURECARLSON@COMCAST.NET <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY <br /> cin. 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 �CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAMED CONTACT PHONE:425-259-0550 <br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existin• Use of Buildin! 10500 <br /> Contract Price of Work. $ <br /> Proposed Use of Building: Heat Source: ❑Gas _DElectric DOther. <br /> BUILDING USE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family!-#Units'„ ❑Commercial ❑Accessory.Structure <br /> T •e of Pro'ect: DNew DAddition ❑Remodel IZIRe•air DTI, ❑Si•n --❑S•rinkler .['Demolition ❑Chan•e of Use <br /> DESCRIPTION OF WORK: <br /> LIKE IN KIND AIR HANDLER AND HEAT PUMP REPLACEMENT <br /> ASSOCIATED BUILDING,,,PERMIT#(if_applicable) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture - • Fixture_--. Fixture __ , Fixture.. _..._ <br /> Count List of Fixtures I" Count List of Fixtures List of Fixtures List of Fixtures <br /> Count , Count <br /> r <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) 4 <br /> Clothes Dryer i Heat Pump&Ductless , Dishwasher ySink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> l Exhaust Fans(Residential Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) , Hose Bibb Urinal <br /> Exhaust Hood(Type II) — �'�Water Heater Interceptor-Grease WastelWater Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> i Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/nsert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other <br /> NY t r Suppte rstt ii'SYetercisto,o earlsChemical uppression Systeemn : o o{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 taw. 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the Stale Contractors Law 18.27 RCW and 296,200A WAG. <br /> ty:of Everett Official Use Onl)e <br /> PERMIT# <br /> .._ � ��/ � <br /> 1r � 02/21!19 D51 <br /> Owner/Authorized Agent Signature CSater' (Rt3vd ;$i: <br />