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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I SIGN /SPRINKLER I 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:1122 Industry St. Everett, WA. 98203 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Mike Smith TENANT BUSINESS NAME(Commercial): ATP <br /> OWNER MAILING ADDRESS: STREET 1122 Industry St. <br /> circ Everett STATE WA ZIP 98203 <br /> OWNER PHONE: OWNER EMAiL: <br /> CONTRACTOR NAME:Owner <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR El OTHER(Please Specify) Agent <br /> CONTACT NAME: CONTACT PHONE:425-754-2295 <br /> Jack LaCasse CONTACT EMAIL:jacklacasse@yahoo.com <br /> BUILDING INFORMATION <br /> Nast, <br /> Existing Use of Building:Office Contract Price of Work:$ 61,51001014. +�2 <br /> Proposed Use of Building:Office Heat Source: OGas [Electric [Other <br /> BUILDING USE: OSFR OTownhouse ODuplex OADU OMulti-Family-#Units: ZCommercial OAccessory Structure <br /> Type of Project: ❑New DAddition ORemodel ❑Repair DTI C1Sign Sprinkler ©Demolition OChange of Use <br /> DESCRIPTION OF WORK: Convert existing 13'x8'storage space to enlarge existing office space. <br /> j - 'duct diffuser in grid. <br /> JASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> FixtureF;xwre 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 Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) i Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system)` Hose Bibb Urinal <br /> Exhaust Hood(Type 11) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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.lam the owner,or/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 /> /dutLsinatur ' <br /> e /J/' <br /> (Revised 10/10/2018) <br />