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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> gn. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3003 W Casino Rd. PROPERTY TAX#: 28041000100200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION` . <br /> OWNER NAME: Boeing Co TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO Box 3707 M/S OH-13 <br /> cm, Seattle STATE WA ZIP 98124-2207 <br /> OWNER PHONE: 425-260-2668 OWNER EMAIL: todd.j.haberlack@boeing.com <br /> CONTRACTOR NAME: <br /> a� 1 WTD 1 MG. <br /> CONTRACTOR ADDRESS: STREET 1)(J ����0//�h��/� OG] `,`rnl C//�J /� <br /> CITY )) 17� `FTY STATE fl/�f/A . ZIP Lg'2P <br /> CONTRACTOR PHONE: VVV«<///111< 1 CONTRACTOR EMAIL: VVV�" <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-260-2668 <br /> Todd Haberlack CONTACT EMAIL: todd.j.haberlack@boeing.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: N/A Contract Price of Work:$ 30,000 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 121Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair I$T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 40-05.1 restroom renovation -Access, selectively demolish and build back plumbing walls per plan <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number 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 EverettOfficial Use Only <br /> , ,/:‘((,&44 <br /> ( 210e. PERMIT riria.,....... <br /> D�/ <br /> Owner//Authorized Agent Signature Date (ReviseYl 10/12/2015) ��� <br /> / I <br />