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OLT PERMIT APPLICATIO <br /> D ►•G0fl <br /> BUILDING•ECHANICAL / PLUMBING / SIGN , RINK / DRIOI47ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201(P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everet+CATcYi/r}t1itEVERETT <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Nermlt Services <br /> PROJECT SITE ADDRESS: 11625 AIRPORT ROAD PROPERTY TAX#: 00537900005402 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SUNRISE CHAPEL TENANT NAME(If Commercial): SUNRISE CHRISTIAN CENTER <br /> OWNER MAILING ADDRESS: STREET 1 1625 AIRPORT ROAD SUITE D <br /> cnY EVERETT STATE WA ziP 98204 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: PERFORMANCE MECHANICAL GROUP <br /> CONTRACTOR ADDRESS: STREET 1012 CENTRAL AVE S <br /> cm, KENT STATE WA ZIP 98032 <br /> CONTRACTOR PHONE: 425-251-0356 CONTRACTOR EMAIL: van.d@PMGHVAC.COM <br /> CONTRACTOR LICENSE#(REQUIRED): PERFOHAISORT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57268 <br /> PRIMARY CONTACT: ❑ OWNER %CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-251-0356 x927 <br /> VAN DUONG CONTACT EMAIL: Van.d.rt PMGHVAC.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: COMMERCIAL Contract Price of Work: $ XXXXXXXXXX <br /> Proposed Use of Building: COMMERCIAL Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex EMulti-Family-#of Units: ®Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: REPLACE 1 EXISTING PACKAGED GASiELECTRIC ROOFTOP UNH WITH NEW IN THE SAME PLACE. <br /> INSTALL 1 NEW ADAPT ER CURB FOR MOUNTING OF THE NEW UNIT ON THE EXISTING ROOF <br /> CURB. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 i 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 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 1 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 /> )�, ,� PERMIT# <br /> V44;1)-4 ,,_'_� 10-11-2022 M2210-033 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> //Z <br />