1728 W MARINE VIEW DR BASE FILE 2021-12-10

4147-7- PERMIT APPLICATION BUILDIN ECHANICAL I PLUMBING I SIGN , ..PRINKLER I DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps@everettwa.gov i www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:1 728 W. Marine View Dr., Suite 112 PROPERTY TAX#:29051800301300 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Port of Everett TENANT BUSINESS NAME(Commercial): none OWNER MAILING ADDRESS: STREET PO Box 538 CITY Everett STATE WA ZIP 98206 OWNER PHONE: (425) 388-0661 OWNER EMAIL:DaleG Q@portofevetett.Com CONTRACTOR NAME: Forma Constriction Co. CONTRACTOR ADDRESS: STREET PO Box 11489 CITY `Olympia STATE WA ZIP 98508 CONTRACTOR PHONE: (206) 573-51 50 CONTRACTOR EMAIL: RobW@formacc.com CONTRACTOR LICENSE#(REQUIRED): FORMACC878OR CITY OF EVERETT BUSINESS LICENSE#(REQUIRELk39 PRIMARY CONTACT: El OWNER El CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (425) 388-0661 Dale Gribble, Properity Manager CONTACT EMAIL: DaleG@portofeverett.com BUILDING INFORMATION Existing Use of Building: Restaurant Contract Price of Work: $ 25,000 Proposed Use of Building: Medical Office Heat Source: ❑Gas DElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: (]Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkl ✓❑Qemolition ❑Change of Use DESCRIPTION OF WORK: Remove existing interior walls, wall/floor coverings, acoustical ceiling & kitchen hood /ducting. Existing restroom to remain. Fuenace system to be replaced with differant permit. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility, laundry, mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression system No.of Heads Chemical Suppression System 'No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT \ A o A _ r z/z� 7 �`r if JIUI 0 ner/ uthorized Agent Signature Date (Revised 10/10/2018) ci )