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• 0 <br />PERMIT APPLICATION <br />BUILDING I MECHANICAL I PLUMBING / SIGN I SPRINKLER I DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />4wrr 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257.8857 f (E) everettevs0everettwa.aov I www.everetiwamov/oermits <br />(Blue or Black Ink Only Please PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: (r��� f-3747 "f VJA q0i I <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Platfsubdivision Lot No. (aftach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: (2400 Oc-t-XE &AL TA 3f Qs)ir es „ VJA TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET l.'3 2 ( �' 04.[+ �I M 46 —tom <br />cnY STATE W A- Zip 9,6 2= of <br />OWNER PHONE: 42.5. :240 1, 45(0 <br />OWNER EMAIL: 3anneS, 18(840n e PrOWd:2rheE. or° <br />CONTRACTORNAME: 1CV-k&)5T Cu 4-&-L. <br />CONTRACTOR ADDRESS: STREET 5 dQ S 3 r d Ave - <br />A <br />cnY T STATE VJ4 ZIP 1�$ IS <br />CONTRACTOR PHONE: .204r . 4 Lo 2 . 3 3 i ( <br />CONTRACTOR EMAIL: c1(.i d i e t,c,) (110 w i <br />CONTRACTOR LICENSE #(REQUIRED): M C K i hJ C L cat A a D N <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 44444 <br />PRIMARY CONTACT: O OWNER ® CONTRACTOR. D OTHER (Please Specify) <br />CONTACT NAME: <br />AU I> l E W P44,A ' <br />ONTACT NE: .204p. q 730- d 43 (c <br />CONT C MAIL: a,k cc1( e. W (30 (Yie k:n5 , Csyri`1 <br />%MQMN FORMATION <br />Existing Use of Building: fiiwALTH Qh<6 Contract Price of Work: $ 2 . 4 2 4 It+ 59 <br />Proposed Use of Building: tt-ALTri r—AIZE Heat Source: OGas ❑Efectric ❑Other <br />BUILDING USE: OSFR OTownhouse ODuplex DADU ❑Multi -Family - # Units: OCommercial OAccessory Structure <br />Type of Project: ❑New OAddifion ❑Remodel ❑Re air MT.I. OSlgn DS rinkler ❑Demolition DChange of Use <br />DESCRIPTION OF WORK: Mechanical work; Phase 1 & 2 on level 9 - Provide and install new supply and exhaust air <br />ductwork distribution and diffusers in 48,000sq ft of space, inc 64 patient rooms and <br />connector space. The new HVAC ductwork distribution is connecting onto existing building <br />central HVAC equipment. <br />ASSOCIATED BUILDING PERMIT # (if applicable): CS 1 R O"A - 002 <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Fixwre <br />Count <br />List of Fixtures <br />Frxtare <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fbctures <br />Fixture <br />Count <br />List of Fixtures �. <br />A/C -Air Handling Units <br />Gas Piping <br />Back(low Preventer(Inside Bldg) <br />Shower, Tub, or Combo <br />Boller <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink,Utility, laundry, mop <br />Exhaust Fans Residential) <br />Commercial Venfilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type I) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />I6terceptor-Sandt,00 <br />Water Service (behind meter <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas FireplaceflnsertlLog 1. <br />256 <br />Air Terminal U <br />' is <br />Roof Drains <br />Water Heater <br />SPRINKLER <br />/ :SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />other, <br />Water Suppression <br />System <br />IF9. of Heads <br />Chemical Suppression System <br />I No. of Heads <br />ACKNOWLEDGEMENT- I hays 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. Deviation 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 1 comply with the State Contractors Law 10.27 RCW and 296.200A WAC <br />Owner/Authoriz gent Signature U Date <br />City of Everett official Use Only <br />PERMIT # <br />//�l ( 430 3 - 06 _j <br />(Revised 1011012018) <br />