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or Black Ink <br />PERMIT A�PLICATIOf� <br />BUILDIN � i uiAE(:NANICAL ! PLUMB�NG / SIGN ,�i RINk�;LER / DEMOLITIOP�d <br />CI7Y OF EVERETT'�ERMIT SERVICES <br />3200 CEDAR STREET, E�VERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everett��ps@everettwa.gov � www.everettwa.govlpermits <br />siTE a�oRess: 3802-B Broa <br />SITE INFOitMAT10N <br />�ROPeRn Ta�c �: 290529003009aC1 <br />for new construction: SYiort Plat/subdivision Lot Nn.__ (attach copy of long legal description) <br />CONTACT INFORM�'�1TION <br />C�NtlNER NAME: CEP-Stc�dlUlll OH LLC TENANI' IVAME (If Commercial): UV�St@Pfl WA M@CiICaI GfOU <br />ONYINER MAILING ADDRES5�: sTReer 2829 R;ucker Ave Suite 10�0 <br />��N Everett STATE Wq Z�P gg2p 1 <br />ovuNER PHONe: Mike - 425.293.9617 OWNER EMAII.:� 171b8IICICI coastmgt.com <br />CONTRACTOR NAME: SOIB Vla <br />CONTRACTOR ADDRESS: srReer � 5551 <br />� . <br />��TM Everett STATE WA Z�P 9820�; <br />CQNTRACTOR PHONE: �2�j.%60.956H CONTRACTOFt LMAIL: JaCOb@SOIc�Vla.net <br />CC'NTRACTOR LICENSE #�REQUIRED): SOLAVV*��18J3 CI"TY OF EVERETT BUSINESS I.ICENSE #(REQUIRED): Q4 I 4F�� <br />PRIMARY CONTACT: 0 C>WNER � CONTRACTOR ❑ OTHER (Please Spf:cify) _ _ <br />Cf,rNTACT NAME: CONTACT PIiU�IE: 42J.760.9cJ6$ <br />Jacob Perkins CONTACT EMAIL: <br />'acob solavi�.net <br />BU9LDING PERMIT APP�.ICATION <br />Existing Use of Building: DOCtOf�S OfFiCe Contract Price of Work: $���� �� ��• � <br />Prcaposed Use of Building: DOCt01'�s Offiee Heat Source: I�Gas DElectric ❑Other <br />Bu�ilding Type: I�SFR-Detach�ed CISFR-Attached ICIDuplex ❑Multi-Famil�-# of Units: I:�Commerciaf ❑Industrial <br />T �:,e of Project: ❑New ❑,tilddition ❑Remodel �Repair �T.I. ❑Sigr� ❑Sprinkler ❑Demolition ❑Change of Use <br />[AESCRIPTION OF WORK: � <br />Tenant Improvement - Move Interior non-structural walls ar�cl install new finishes <br />for a new doctor's office <br />ASSOCIATED BUILDING PIEF�MIT # if a licable): <br />PLUMBING PERMB'i APPLICATION <br />Type af Project: New Addn Alteration Repair <br /># of l,ist of Fixtures #°� List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bld ) <br />Bathtub Urinal � <br />Lavatos (Wash Basin) �� Drinking Fountain <br />Shower Floor Drain <br />KitchPn Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />AC'KNOWLEDGEMENT: I have reviewed this application and conliirn the information contained herern is true and correcf. Work done pursuant to this permit must c�mply with <br />current federal, state, and local la�v. The granting of a permit onry authorizes approved work and no deviations therefrom. Deviatrons rnust frrst be authonzed in writing from the <br />Bui'ding OHicial before being authonzed under any circumstance. 1 arn the owner, or I am authorized by the owner of this property to parform the work for which application is made, <br />and 1 comply with the State Contracfors Law 18.27 RCW and 296.20�A WAC. <br />Cr.ry of EvereK O(frcial Use Only <br />, PERMIT� <br />��3 /G � _ <br />ate (Revised 0/2G � 6) <br />