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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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink.OMy Please) pROJECT SITE INFORMATION �`�`� `;' �` <br /> PROJECT SITE ADDRESS:9O6 SE EVeI'@tt MaII Wa�/, Everett, WA 98208 PROPERTY TAX#: OS((70� 5� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> owNeR Nanee: Pflueger Everett Holdings, LLC TENANT NAME(If Commercial): T-MObll@ <br /> OWNER MAILING ADDRESS: STREET 19807 North Creek Pkwy N <br /> ,T,�Bothell STATE WA z�P 98011 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR N E; TBD � '� <br /> CONTRACTOR RESS: srReer <br /> cirv STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ): �� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 8 OTHER(Please Specify) ' <br /> CONTACT NAME: CONTACT PHONE: g58-754-2151 <br /> Jessica Barry, MCI7 CONTACT EMAIL:jbarry@md <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: TeleCOm Contract Price of Work:S 50 000 <br /> Proposed Use of Buildin :Telecom Heat Source: ❑Gas ❑Electric ❑Other N/A <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> T e of Pro'ect: ❑New DAddition ORemodel ❑Re air ❑T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: pv� �, �.� �,g�tp�.-�C �3 on�ry�4J,Zi�1 �� Yte_w oh�-�+�g� 8 <br /> kjallas�►-��`''e5� (3 'P �'tc.�U 5 o�G C� FH-ag�s.'Qeloca C31 �Rc.F,•s�C3 �Tt��s;sr,s-�a� Cau��p�,-s <br /> ASSOCIATED BUILDING PERMIT# if a licable : <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 #°f Llst of Fixtures #of ��st of F/xtures #of List of Fixtures <br /> Fixtures Fixtures Fixfures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato Wash Basin Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes D er Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mo /etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed thls application and confirm the information contained he�in is hue and correct.Work done pursuant to this permit must comp/y 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 O�cial 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 O/ficial Use Only <br /> � � PE�# ,�. ��� <br /> �� <br /> er/Authorize ent Signa re ate (Revised 9/23/2016) <br /> %� ,-� <br />