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PERMIT APPLICATI�I <br /> BUILDIN--�VIECHANICAL/ PLUMBING I <br /> SIG�i PRINKLER/ DEMOLITION <br /> /1411:%;'"--A. CITY OF EVERETT PERMIT SERVICES <br /> J 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> SI}!e $1 J b4001,0asef . _ . ,PROJEC'll'.AIT;E i# RMS' 1 r <br /> PROJECT SITE ADDRESS: 4310 Colby Avenue PROPERTY TAX#: 00582202600200 <br /> LEGAL for new construction: Short Plat/subdivision EVERETT REPLAT BLKS 19 TO 28 BLK 026 Lot No. 21&22 (attach copy of long legal description) SEE ATTACHED <br /> ' �p ;l'.. r a 1 <br /> :./ .. ONTAtT II1F� ,. ..�1.: . _�,, ��,�._.. ��� P.� '� _,xm <br /> OWNER NAME: PETERSEN AND HILDAHL LLC TENANT NAME(If Commercial): Western Washington Medical Group <br /> OWNER MAILING ADDRESS: STREET 2105 112TH AVE NE STE 102 <br /> ciTY , BELLEVUE STATE WA zip 98004 <br /> OWNER PHONE: 206.499.3815 OWNER EMAIL: cheryl.m@petersonhildahl.com <br /> CONTRACTOR NAME: Performance Mechanical Group <br /> CONTRACTOR ADDRESS: STREET 1012 Central Avenue South <br /> or( Kent STATE WA ZIP 98032 <br /> CONTRACTOR PHONE: 425-251-0356 CONTRACTOR EMAIL: mark@pmghvac.com <br /> CONTRACTOR LICENSE#(REQUIRED): PERFOHA15ORT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57268 <br /> PRIMARY CONTACT: 0 OWNER ?CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-251-0356 <br /> Mark Smeltzer CONTACT EMAIL: mark@pmghvac.com <br /> _ BUILDING,'-PERMIT APP.ICA"TLON � . ... ,,. <br /> Existing Use of Building:Medical Offices Contract Price of Work:$ $37,000.00 <br /> Proposed Use of Building: na Heat Source: ❑Gas IZI Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: IaCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace existing cooling tower with new unit of same capacity &same dimensions. <br /> New tower to be installed in same location. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): NA <br /> �' ���� yam �,ka e�>�� x # � ,�� y ����r t _-,_,�,t '�'- h '�%`r � r` '' �`�>a rte �� �^'��3��R "i <br /> N IrA <br /> � ;�.���� , �..� »..,,H,fi�,��l`T��IPPLICA,TION '... � � ..u,�.. . v,..����. �,��Lll�, „��...,� 1 `P�,�Y� �����,.,a �._,, . f �`: <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 Water Heater Other: <br /> Exhaust Fan cooling tower Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSIONSYSTEM;:I <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> f-iePERMIT# / g /'(_ d/3 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) 1I <br />