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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER I 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 I www.everettwa.gov/permits <br /> Moo or.Slack Ink Only Plow) PROJECT SITE,INFORMATION <br /> PROJECT SITE ADDRESS:3419 NORTON AVE PROPERTY TAX#:00437582601000 <br /> LEGAL for new construction: Short Plat/subdivision Lot Mx (attach copy of long legal description) <br /> CONTACT INFORMATION::, <br /> OWNER NAME: KATE HAAGEN TENANT BUSINESS NAME(Commercial); <br /> OWNER MAILING ADDRESS: STREET3419 NORTON AVE <br /> oily EVERETT STATE WA zip 98201 <br /> OWNER PHONE: 425-231-2492 <br /> �oWNER EMAIL:KMHAAGEN@GMAIL.COM <br /> x <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STReer 1415 BROADWAY <br /> ciw EVERETT STATE WA Zip 98201 <br /> CONTRACTOR PHONE:425-259-0550 <br /> CONTRACTOR EMAIL:DEBBIE@CMHEATING.COM <br /> CONTRACTOR LICENSE REQUIRED):CMHEAI*09554 ClT(OF EVERETT BUSINESS LICENSE#(REQUIRED): 016098 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAILANA CONTACT EMAIL:KAILANAc(DCMHEATING.COM <br /> BUILDINGNFORMATIION` <br /> Existing Use of Building Contract Price of Work; 5000 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE:,EISFR_.,.. ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New ©Addition ❑Remodel DRepair DTI ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION`Or WORK' SINGLE ZONE DUCTLESS HEAT PUMP INSTALL <br /> ASSOCIATED BUILDING PERMIT#(if eppiicable), <br /> MECHANICAL PERMIT APPLICATION „ <br /> PLUMBING PERMIT APPLICATION <br /> Fixture Fuge Fixture Ffxtur@ <br /> count List of Fixtures Court List of Fixtures List of Fixtures List of Fixtures <br /> ACC-Air Handling Units` Gas Piping Backflow Preventer(Inside Bldg) ' Shower,Tub;,or Combo <br /> Boiler Gas Range Clothes Washer a;Sink-Commercial(3-comp,pre,floor) <br /> Clothes Dryer i Heat Pump&Ductless '- Dishwasher _ - Sink-Residential(kitchen,bath,bar) <br /> Duct System,(Rempdel), Refrigeration Drinkir g,Fountain �5ink-Utility3 laundry,mi p <br /> Exhaust Fans(Residential Commercial Venblatio, ' Floor Drain Toilet <br /> IIIExhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type Il) 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 <br /> Gas Fireplace/Insert/Log Roof Drains ._ vvater Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> r ater S:uppresston System. M1fo.oft-eads <br /> I <br /> Chemit t: appressien Sy#t+3n1 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 /> 4 of Everett Official Use Only <br /> irn <br /> ,/ 4cILA/f/.e1-71x4, 05/01/1 s.... . `P lR O S 'r`" <br /> Owner/Authorized Agent Signature Date i(F. 1/1 1O"f 149. <br />