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PERMIT APPLICATIO <br /> BUILDINC--IECHANICAL/ PLUMBING /SIGN , NPRINKLER / 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 /> 2.Jpd -To�.Or�jZPROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 80 tete!FflE)Fe Ave PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision.. __ _Lot No._ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: State Of WA, DES - Jonathan Martin TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 500 Jefferson Street <br /> CITY Olympia STATE WA ziP 98504 <br /> OWNER PHONE: 360-239-3350 OWNER EMAIL: <br /> CONTRACTOR NAME: To be determined 1_c e UL Rj uk-3 CCR-76; EITO <br /> CONTRACTOR ADDRESS: STREET Pe' 1p'G 6 jj C[ <br /> CITY �E- �'Z�_V 46- STATE L ZIP <br /> CONTRACTOR PHONE CONTRACTOR EMAIL: �!2i<eoti F G.% Plc-6, (F taii_% LSM <br /> CONTRACTOR LICENSE#(REQUIRED): N l J S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR 0 OTHER(Please Specify) Engineer <br /> CONTACT NAME: Michael Tagles, PE CONTACT PHONE: 253-383-3257 <br /> HultzlBHU CONTACT EMAIL: michaelt@hultzBHU.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Classroom, Admin lContract Price of Work: $ <br /> Proposed Use of Building: Classroom, Admin lHeat Source: [KGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: MCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel [BlRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Ceilings in certain areas will <br /> be replaced to accommodate HVAC work. oi+ens- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o roject: _New Addn XAlteration _XRair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #ofXt <br /> f Fixtures #of st of Fixtures #of List of xtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 9 A/C— Handling Units Heat Pump Toilet Backflow eventer(Inside Bldg) <br /> Forced Air stems Unit Heater Bathtub Uri <br /> Gas Piping 2 Boiler Lavatory(Wash Basin) rinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range 1 Ducting Dishwasher of Drains <br /> Clothes Dr r Hookups Other: Clothes Washer MeAi Gas <br /> Range ood Water HeatOther: <br /> 4 ExhAst Fan Sink(S Ice/Bar/Mop/etc.) Other: <br /> ,,-'SPRINKLER/ SUPPRESSION SYSTE <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> OwneQAuthorized Agent Signature Date (Revised 10/12/2015) '� .Z <br />