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PERMIT APPLICATIO� <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� wvuw.everettwa.gov/permits <br /> �., �� �,: � _ � y . <br /> � �. <br /> (B�� e ow�lack'�'�k Oniy Pl�ase)`° P JECt SITE INFORIV�ATION �� }�. ; `��" . <br /> PROJECT SITE ADDRESS: 1502 SE Everett Mall Way PROPERTY TAX#: 28051800401100 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> � " ����� � � � � �,�ONTACT 1�1FORIVIATION � � � � <br /> OWNER NAME: 3733 Investments LLC. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer 433 N Camden Dr., Suite 800 <br /> ciTv Beverly Hilis sTATE CA zia 90210 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME;Evergreen Refrigeration <br /> CONTRACTOR ADDRESS: srneEr 727 South Kenyon St. <br /> cirr Seattle STATE WA ziP 98108 <br /> CONTRACTOR PHONE: 206-763-1744 CONTRACTOR EMAIL: alexb@evergreenhvac.com <br /> CONTRACTOR LICeNSE#�REQuiRE�): EVERGRL954R2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):044350 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:Alex Burkhart CONTACT PHONE:206-763-1744 ext. 247 <br /> CONTACT EMAIL: alexb@evergreenhvac.com <br /> , BUILDIN�z,PER11111T APPLICATION;, . .;; <br /> Existin Use of Buildin : Contract Price of Work:$313,146.00 <br /> Proposed Use of Buildin : Heat Source: as ❑Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ommercial ❑Industrial <br /> T pe of Pro'ect: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> �eSCR�PT�ON OF WORK: �nstallation of twenty-one(21) rooftop units and twenty-one(21)gas piping outlets. <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MECHANICAL PERMIT APPWCATION PWMBING 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 #°f List of Fixtures #of List of Fixfures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 2� A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> 21 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration 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/Mo /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 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 /> ��r ' � Y ' PERMI� ����� � <br /> r�''� ��L �� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) � <br /> �- <br />