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El <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 2305 1 OOTH ST SE, EVERETT, WA 98208 <br />1PROPERTY TAX #: 28051700305600 <br />LEGAL for new construction: Short PlaUsubdivision <br />(attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: SILVER LAKE WATER & SEWER DISTRICT TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 15205 41 st Avenue SE <br />CITY Bothell STATE WASHINGTON ZIP 98012 <br />OWNER PHONE: 425-337-3647 <br />OWNER EMAIL: rqgilmore@slwsd.com <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 4EI OTHER (Please Specify) Engineer at Gray & Osborne, Inc. <br />CONTACT NAME: P.E. <br />Eric Delfel, f . E. <br />CONTACT PHONE: 206-284-0860 <br />CONTACT EMAIL: edelfel@g-o.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: WATER UTILITIES and STORAG <br />Contract Price of Work: $43+,-908 17 t <br />Proposed Use of Building: WATER UTILITIES and STORAGE <br />Heat Source: ❑Gas OElectric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial Oindustrial <br />Type of Project: ❑New ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: / / <br />Booster Station remodel, see attached Plans for details !-112W( I7-C le-\/ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration <br />_Repair <br />Type of Project: _New _Addn <br />_Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />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 />Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # 1 <br />(Revised 912312016) U U <br />