Laserfiche WebLink
OLT PERMIT APPLICATION <br /> BUILDING ECHANICAL / PLUMBING / SIGN I RINKLER / DEMOLITION <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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 12906 Bothell-Everett-+- — PROPERTY TAX#:280530-004-062-00 <br /> LEGAL for new construction: Short Plat/subdivision A(Lt — Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Fred Meyer Stores, InC. TENANT NAME(If Commercial): Fred Meyer <br /> OWNER MAILING ADDRESS: STREET 3800 SE 22nd Ave c/o Tim Anderson <br /> CITY Portland STATE OR ZIP 97202 <br /> OWNER PHONE: (503") 797-3885 - OWNER EMAIL: tim.anderson@fredmeyer.com <br /> '- .0 • <br /> CONTRACTOR NAN - 1`4L PTL-I,' ' ..._2 ., y. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP - <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:C(� C,V c7 <br /> ` .) S <br /> CONTRACTOR LICENSE#(REQUIRED): �-�.� \ `\-�� 5 � Y OF EVERETT BUSINESS LICENSE#(REQUIRED): Lt C(t \A--- <br /> 1., <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR El OTHER (Please Specify) Engineer/Architect <br /> CONTACT NAME: Joel Howitt C/O CONTACT PHONE: (425) 251-6222 <br /> Barghausen Cons. Engrs., Inc. CONTACT EMAIL: jhowitt@barghausen.com <br /> BUILDING PERMIT APPLICATION l <br /> Existing Use of Building: Retail Contract Price of Work: $ 250.00 <br /> Proposed Use of Building: Retail Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: -- ®Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ®Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 new double sided sign bracket, 2 new 48" x 36" signs. <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 #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures 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 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <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 /> I City of Everett Official Use Only <br /> "��f PERMIT# 1�� `� <br /> Ow Authorized Agn 1 l <br /> t ignature Date (Revised 9/23/2016) r (` ) <br />