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4rEn- PERMIT APPLICATION <br /> BUILDING ECHANICAL / PLUMBING / SIGN r --INKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1000 SE Everett Mall Way, Suite 401 PROPERTY TAX#:28051800305401 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Pflueger Everett Holdings, LLC TENANT BUSINESS NAME(Commercial): U.S. Census Bureau <br /> OWNER MAILING ADDRESS: STREET c/o Colliers International,John Bausch, RPA, 6500 Harbour Heights Pkwy, Suite 107 <br /> CITY Mukilteo STATE WA ZIP 98275 <br /> OWNER PHONE: (425„1315_-_1„3\54 OWNER EMAIL:john.baush@colliers.com <br /> CONTRACTOR N E:TBD 1 , A \ I nit I m I` u. <br /> CONTRACTOR AD S: STREET <br /> CITY �� STATE ZIP <br /> CONTRACTOR PHONE: 1CONZRACTOR EMAIL: �f e I -S 3 /17 <br /> CONTRACTOR LICENSE#(REQUIED): \- CITY OF EVERETT BUSINESS LICENSE#(REQUI4R1V141/0- <br /> - <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR El OTHER(Please Specify) ARCHITECT <br /> CONTACT NAME: CONTACT PHONE:(425)582-5503 <br /> Cindy Kang CONTACT EMAIL:ckang@waremalcomb.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:B-Office Contract Price of Wor : $109,000 <br /> Proposed Use of Building:B-Office Heat Source: ❑Gas ectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition Remodel El Repair CIT.'. Sign Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: The scope of this project includes demolition of a selected wall; relecatfomof-of-exist4ng-light fixtures;- <br /> and construction of (1) storage room & (1) multi-purpose room <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pum.; Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Ref .eration Drinking Fountain Sink-Utility,laundry, mop <br /> Exhaust Fans(Residential) ommercial Ventilatior Floor Drain _ " Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Resi•- tial) Wood Stove Interceptor-Sand/Oil-"' Water Service(behind meter) <br /> Forced Air Syste• s Other: Medical Gas / Water Valves or Fixtures <br /> Gas Firepla • Insert/Log Roof Drai9s" Water Heater <br /> SPRIN ER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppress'on System No.of Heads <br /> Chemical Suppression System 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.lam 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 /> PERMIT# <br /> , 1,,. OI/ 0 d7/2I (901 — D< <br /> Owner'Authoriz Agent Signature Date (R ised 10/10/2018) <br />