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4rETT 0 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 830 80th St SW, B100 PROPERTY TAX#: 28041200305300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Covewood Manor LLC TENANT NAME(If Commercial): ReNu Medical <br /> OWNER MAILING ADDRESS: STREET 600 108th Ave NE, #340 <br /> crry Bellevue STATE WA ZIP 98004 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Evergreen Refrigeration <br /> CONTRACTOR ADDRESS: STREET 727 South Kenyon St. <br /> ciTv Seattle STATE WA ZIP 98108 <br /> CONTRACTOR PHONE: 206-763-1744 ,CONTRACTOR EMAIL: alexb@evergreenhvac.com <br /> CONTRACTOR LICENSE#(REQUIRED): EVERGRL954R2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):044350 <br /> PRIMARY CONTACT: 0 OWNER OCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Alex Burkhart CONTACT PHONE:206-763-1744 ext. 247 <br /> CONTACT EMAIL: alexb@evergreenhvac.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$6,348.00 <br /> Proposed Use of Building: Heat Source: OGas 1�Electricc��❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex�Multi-Family-#of Units: HCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair l�T.1. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Installation of five (5) electric wall heaters and three (3) exhaust fans. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): B2106-015 <br /> MECHANICAL PERMIT� APPLICATION� PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn /Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 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 5 Electric Wall Heater Water Heater Other: <br /> 3 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 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,% v----------- fi (27 h21 M 2 I 0°1 - 1 0 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> r/7 <br />