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PERMIT APPLICATION <br /> ,/ BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER / 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 1 www.everettwagov/permits <br /> ..— <br /> (aim or Black ink Only Pltirano) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:9727 18TH AVE W UNIT B203 PROPERTY TAX#:00854500220300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> r <br /> OWNER NAME: CONNIE DUBOIS TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET9727 18TH AVE W UNIT B203 <br /> CITY EVERETT STATE WA ZIP 98204 <br /> OWNER PHONE: l,6.(; 2 2-.` 2 L'`"L OWNER EMAIL:C\(246,.,--7k.„---, t_c::- vi.,\ \'2:L; k=- , r' ._ t'' <br /> CONTRACTOR NAME:C.M. HEATING INC <br /> CONTRACTOR ADDRESS: STREET 1415 BROADWAY - <br /> cm( EVERETT STATE WA zip 98201 <br /> CONTRACTOR PHONE:425-259-0550 CONTRACTOR EMAIL:KAI LANA@CMHEATI NG.COM <br /> CONTRACTOR LICENSE#(REQUIRED):CM HEAI*09554 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 016098 <br /> PRIMARY CONTACT: ❑OWNER C]CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0550 <br /> KAI LANA CONTACT EMAIL:KAILANA@CMHEATING.COM <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: '$4800 <br /> Proposed Use of Building: Heat Source: ❑Gas MElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex OADU ©Multi-Fami�-#Units:143 ❑Commercial EAccessory Structure <br /> Type of Project: New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> . ____._ ... .. <br /> DESCRIPTION OF WORK: SINGLE ZONE DUCTLESS HEAT PUMP INSTALL <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture - Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—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 1 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 HeaUAC 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 /> J Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/InserULog Roof Drains Water Heater <br /> SPRINKLER I 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./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 /> v / A , J PERMI # <br /> l .L,,,, � <br /> os/avis ���I �g <br /> � ��� 0 <br /> Owner/Authorized Agent Signature v Y� Date (Revised Wf10/2018) <br /> { <br /> I <br /> f <br />