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0 0 <br />PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <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 l (E) everetteps@everettwa.gov I vvww.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1010 SE Everett Mall Way Suite 104 <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Everett Mall Office Building LLC <br />TENANT BUSINESS NAME (Commercial): <br />Northwest Kidney Centers <br />OWNER MAILING ADDRESS: STREET 1429 Ave D PMB 521 <br />clry Snohomish <br />STATE WA <br />zip 98290 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: Western States Fire Protection <br />CONTRACTOR ADDRESS: STREET 14690 NE 95th Street <br />CITY Redmond <br />STATE WA <br />71P 98052 <br />CONTRACTOR PHONE: 425-881-0100 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): WESTESF136QF <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 20553 <br />PRIMARY CONTACT: ❑ OWNER El CONTRACTOR ❑ OTHER (Please Specify) <br />_ <br />CONTACT NAME: <br />Jameson Gavac <br />CONTACT PHONE: 206-503-3174 <br />CONTACT EMAIL: Jameson.Gavac@wsfp.us <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: 5 2000 <br />Proposed Use of Building: <br />I <br />Heat Source: []Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR F 1Townhouse FlDuplex r`ADU []Multi -Family - # Units: CCommercial <br />DAccessory Structure <br />Type of Project: CNew ❑Addition CRemodel ❑Repair <br />❑T.I. ❑Sin 6Sprinkler CDemolition <br />❑Chan e of Use <br />DESCRIPTION OF WORK: Adding 1 head to protect oxygen tanks being installed <br />ASSOCIATED BUILDING PERMIT # (if applicable). <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />ArC — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep.floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen. bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilation <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Unnal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplacerinsert'Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />I <br />lNo, of Heads <br />Chemical Suppression System <br />I <br />lNo. of Heads <br />ACKNOWLEDGEMENT: l have rewev:ed this applcation and confirm the information contained herein is true and correct Wort, done pursuant to this permit must comoly 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 arm the owner, or l 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 />Ja'ncson Gavac D'a: 2020 <br />Owner/Authorized Agent Signature Date <br />01ty of Everett Officia.' Use Only <br />PERMIT/ D� <br />(Revised 10 10 2018) I Wn <br />