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PERMIT APPLICATION <br /> er.4411P4104;_,- 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 (E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Blue,or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6133 Lake Chaplain Rd. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: City of Everett TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3002 Wetmore Ave. {✓y�y q <br /> crit/ Everett STATE A ZIP 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Blythe Plumbing and Heating, Inc. <br /> CONTRACTOR ADDRESS: STREET 2201 Humboldt St. <br /> CITY Bellingham STATE WA zip 98225 <br /> CONTRACTOR PHONE: 360-733-7810 CONTRACTOR EMAIL: MalCOlmt@blytheinC.COm <br /> CONTRACTOR LICENSE#(REQUIRED): BLYTHI*2381 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0 P?)(0 q 0 <br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Malcolm Thomson CONTACT PHONE: 360-733-7810 <br /> CONTACT EMAIL: Malcolmt@blytheinc.com <br /> BUILDING,PERMIT APPLICATION......;;.:, <br /> Existing Use of Building: Contract Price of Work:$ 01.,q) Si , <br /> Proposed Use of Building: Heat Source: DGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Simple replacement of ductless split A/C system for Server Room. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repalr Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> 1 A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain _ <br /> Water Heater Refrigeration Shower _ Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER;/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application end confirm the information contained herein is tele and correct.Work done pursuant to this permit must comply with <br /> current federal,state,end local law.The granting of a permit only authonzes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Budding 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 /> OP .14 <br /> / n 12- I <br />