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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: 1106 SHUKSAN WAY EVERETT, WA. <br />PROPERTY TAX#: 2950887 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: EVERETT COMMERCE CENTER TENANT NAME (If Commercial): - <br />OWNER MAILING ADDRESS: STREET N/A <br />CITY STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: UNIVERSAL REFRIGERATION <br />CONTRACTOR ADDRESS: STREET 4102 B PL . NW. <br />crTv AUBURN STATE WA ZIP 98001 <br />CONTRACTOR PHONE: (253) 939-5501 <br />CONTRACTOR EMAIL: @UNIVERSALREFRIG. COM <br />CONTRACTOR LICENSE #(REQUIRED): UNIVERI159RF <br />CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 027645 <br />PRIMARY CONTACT: ❑ OWNER ® CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />AIDAN WILSON <br />CONTACT PHONE: (253) 939-5501 <br />CONTACT EMAIL: DESIGN @UNIVERSALREFRIG . COM <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: WAREHOUSE <br />Contract Price of Work: $ 12,950.00 <br />Proposed Use of Building: <br />Heat Source: I29Gas ❑ 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: INSTALL NATURAL GAS PIPING TO SEPERATE FOR (3) GAS METERS <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: X New Addn Alteration Repair <br />Type of Project: New _Addn 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 />4 <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 />Chemical or Water <br />I <br />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 file <br />Building Official before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application Is made, <br />and 1 comply with file State Contractors Law 18.27 RCW and 296.200A WAC. <br />ry1 y� Digitally signed by Aidan Wilson City of Everett Official Use Only <br />AI1.1 1 1 W I I SO DN: cn=Aldan Wilson, o, ou, PERMIT # <br />email=019,0.12 9:25:06-c=US 09/15/22 <br />Date: 201l.07.12 0l:25:06 �07'00' <br />Owner/Authorized Agent Signature Date (Revised 912312016) <br />