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PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITIONCITY 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 I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS:3702 ROCKEFELLER AVENUE PROPERTY TAX#:00438192203100
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME: KAY HOLLEN BECK TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3702 ROCKEFELLER AVE
<br /> CITY EVERETT STATE WA ZIP 98201
<br /> OWNER PHONE: 425-38-7248 OWNER EMAIL:NA
<br /> CONTRACTOR NAME:C.M. HEATING INC
<br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY
<br /> CITY 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: 0 OWNER CI CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-259-0550
<br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM
<br /> toOlt � s �
<br /> Existing Use of Building: Contract Price of Work:$5500
<br /> Proposed Use of Building: Heat Source: ❑✓Gas ❑Electric ❑Other
<br /> BUILDING USE: IZISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New DAddition ❑Remodel ©Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: LIKE IN KIND GAS FURNACE CHANGE OUT
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ;< . ANI PERMICOPUCATI ..,` S H,r,... 4 ?,,
<br /> FixtureFixture Fixture Fixture
<br /> Count List of Fixtures coupe List of Fixtures Count List of Fixtures Count List of Fixtures
<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 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 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 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 /> ,NN ,y
<br /> •woo `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.lam 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 /> �j,, / � ) ,,f/� �. )l City of Everett Official Use Only
<br /> /1.tYC L(V/L/.CQ i /fi'C, PER I (.$1.D` — O(05
<br /> 01/15/19 1 `
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018)
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