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PERMIT APPUCATIC <br /> � BUILDING / MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> y 3200 CEDAR STREET, EVERETT,WA 98201 <br /> � (P)425-257-8870 � FAX 425-257-8857 �{E)everetteps@everettwa.gov( wvuw.everettwa.gov/permits <br /> a � _ . . <br /> � 'Blue ar Black Mnk'�nl Plaas� PRt�.IECT$ITE�N��IRMATtDN ' <br /> �ROJECT SITE ADDRESS: 1�J SW EVERETT MALL WAY SPACE G-H PROPERTY TAX#: OO4SOZO1 1 O'I 4OO <br /> � LEGAL for new construction: Short PlaUsubdivision -- Lot No. _(attach copy of long legal description) <br /> _ � "CONTACT INFflRMAT[OIYI <br /> owNER NAME: ROSEN BEL-KIRK ASSOCIATES LLC TENANT NAME(It Commercial}: VIDA INTEGRATED HEALTH <br /> :; QWNER MAILING ADDRESS: s,x�ET PQ BQX_S:QO� _ <br /> , _ cnv BELLEVUE _ __ _ sTnrE WA ziP 98009 <br /> �3W��R"PHANE: __ 't���'i�MAI.L: <br /> coNrRacroR NnMe; EMERALD AIRE, INC. _ _ __ <br /> _ _ <br /> �ONTRACTOR ADDRESS: srREer 5108 D ST NW <br /> __ __.. _ _._ <br /> _ _ _ _ _ _ ___ __ __. <br /> cirv AUBURN _ srn-re WA_ _ ziP 98001 _ <br /> _... <br /> coNrriaCro��HONe: 253-872-5665 Co�rwe►croR eMai�;, PERMiTS�EMERALDAIRE.COM_ <br /> , , - _ <br /> CONTRACTOR LICENSE#(REQUIRED): EMERAAIOS�JBL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED�:OZZS19 <br /> _ _ <br /> PRIMARY CONTACT: ❑OW NER p1 CONTRACTOR ❑OTHER{Please Specify). <br /> CONTACT NAME: : CONTACT PHONE: 253-872-�665 <br /> M I RAN DA M EN D EZ CONTACT EMAIL:pERMITS@EMERALDAIRE.COM <br /> B�JII.f�1�Cs:PERM:IT AP�LIGAT�t��1 =; <br /> Existin .Use of Buildin : COMMERCtAL Contract Price of Work:$$41,342 <br /> _ ,... <br /> Pr osed Use of Buildin :MIXED USE _ Heat Source. :OGas DEleatric ❑Other <br /> �uiidin T e: ❑SFR-Detached ❑SFR:Attached ❑Du lex ❑Multi-Famil -#of Units;. lC7Commercial �Industrial _ <br /> _ , . <br /> T e of Pro'ect: ❑New DAddition ❑Remodel ORe,air OT.L ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: . <br /> INSTALLATION OF DUCTWORK, GRILLS, AND EXHAUST FANS <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> . <br /> MECN/kN{CAL PERMIT APPLIGATION 'i - ' PLUMHING PERMIT APPLICA"�ON' <br /> __ <br /> Type of Project: _New Addn ,�Alteration Repair Type of Project: _New _Addn Alteration _Repair <br /> #of_ _ _ #of _ _ #of __ . __ #of , _._ __ <br /> list of Fixtures List of�ixtures List of Fixtures List of Fixtures <br /> fixtures Fixtures F(xtures . Fixtures <br /> �G-�'F��dli i�� Heat Pump ; Toilet Back�low Preventer Inside Bld <br /> ' Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pi. in Boiler tavafo Wash Basin Drinkin -Fountain <br /> Water HHeater Refri eration 5hower . ° <Floor I]rain <br /> Gas Fire lace Wood Stove �CltChen Sink&Dis osat Grease Tra <br /> ' Gas Ran e Ductin Dishwasher ` Roc�f Cfrains <br /> ' Clothes D er Hooku s 4 Other:ap�«s Clothes Washer Medical Gas <br /> ' ' Ran e Hooci Water Heater Other: <br /> ' Exhaust Fan Sink Seroice7BarJMo 7etc.: ' 'Other. <br /> _ __ <br /> ; SPRINKLER/:SUPPRESSION SYSTEM,, <br /> Number of Heads _....... _ <br /> _ : _.. <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the informetion contained harein is true and correct<Work dorre pursuant to this permit must comp/y wrth <br /> current tederal,stale,and local law. The grenting of a permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized irt writrng from!he <br /> 8uilding O�cial before being authorized under any circumstance,f am the owner,or 1 am authorized by[he owner of�his propeny to perform the work for which application is mede, <br /> and(comply with the State Contractors Law 18.27 F2CW and 296.200A WAC. <br /> Crty of Everett OKicia!Use Only <br /> PERMIT# <br /> � , _ �� r t' . l� `-' Do�3 ._. <br /> : <br /> C� erlAu d: Signat�re' i�..: .: ' ' �' `�ett:9C�31Z{?�#8j <br />