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4M- PERMIT APPLICATION <br /> BUILDING OECHANICAL / PLUMBING /SIGN / 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3003 W Casino Rd. PROPERTY TAX#: 28041000100200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Boeing Co TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO Box 3707 M/S OH-13 <br /> CITY Seattle STATE WA ZIP 98124-2207 <br /> OWNER PHONE: 425-260-2668 OWNER EMAIL: todd.j.haberlack@boeing.com <br /> CONTRACTOR NAME: Dahlgren Industrial, Inc. <br /> CONTRACTOR ADDRESS: STREET 13975 Interurban Ave S, Suite 100 <br /> ciTY Tukwila STATE WA ZIP 98168 <br /> CONTRACTOR PHONE: 206-236-2300 CONTRACTOR EMAIL: jeffw@dahlgrenindustrial.com <br /> CONTRACTOR LICENSE#(REQUIRED): DAHLGI1988BQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 042200 <br /> PRIMARY CONTACT: ® OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-260-2668 <br /> Todd Haberlack CONTACT EMAIL: todd.j.haberlack@boeing.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: N/A Contract Price of Work: $_2,000 <br /> Proposed Use of Building: Relocated Office and Restroom Trailer Heat Source: ❑Gas ❑Electric ®Other NONE <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial C Industrial <br /> Type of Project: ®New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />' DESCRIPTION OF WORK: <br /> Stall 113/115 Building Modifications: <br /> • Relocate building 45-767 (Office Trailers) and 45-900 (Restroom Trailer) from their existing location in Stall 113 to <br /> new locations in Stall 115. <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump/ <br /> 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 /> Dishwasher <br /> Gas Range Ducting 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 /> 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 /> City of Everett Official Use Only <br /> �} ti April 3, 2020 PERMIT# <br /> MI2 CD6 ro 3 <br /> Owner/Authorized Agent Signature for Todd Haberlack Date (Revised 10/12/2015) <br /> Vz._ <br />