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PERMIT APPLICATIOI� <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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> x.�... <br /> '(Blue ar Black lnk";On1y,Please) PROJECT,SITE'.INFORMATION <br /> PROJECT SITE ADDRESS: 3202 Colby Avenue PROPERTY TAX#: 00439176802500 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ` ' CONTACT INFORMATION <br /> OWNER NAME: Salama William M MD TENANT NAME(If Commercial): LabCo1'p <br /> OWNER MAILING ADDRESS: srReer 2415 Taylor Dr <br /> �,n Everett STAiE WA ziP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: PSF Mechanical, Inc. <br /> CONTRACTOR ADDRESS: sTReer 11621 E Marginal Way S, Suite A <br /> ciTv Seattle srATe WA zia 98168 <br /> CONTRACTOR PHONE: 206-812-7683 CONTRACTOR EMAIL: permits@psfinech.com <br /> CONTRACTOR LICENSE#(REQUIRED): PSFMEI*O9ONZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRE :02633 <br /> _ .. __ <br /> _ _.,. _. _. _ _ _ _ ,_ . ___ <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-812-7683 <br /> Amanda Moore coN7'acr ennA��: permits@psfinech.com <br /> BUILDINCs:;PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:$2,100..00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition j�`IRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Relocate(2)existing supply diffusers& replace(2)ceiling exhaust fans vented to existing roof vents. <br /> ASSOCIATED BUILDING PERMIT# if a licable : <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 Lisf of Fixtures #of List of Fixtures #°f List of Fi�ctures <br /> Fixtures Fixfuies Fixfures Fixfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air S stems 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 2 OthEP:S1A diffusers Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 2 Exhaust Fan Sink(Service/Bar/Mop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and con�rm the information contained herein is true and correct.Work done pursuant to this permit must compty 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 fhe owner,or I am authorized by the owner of this property to pertorm the work for which applicafion is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A W,4C. <br /> Cify of Evere#Official Use Only <br /> Digitally signed by Amanda Moore PE <br /> �iy����'e Date: 2017.12.05 06:07:08-08'00' �l�`2— O� S <br /> `, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> / <br />