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0 PERMIT APPLICATIO14 <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 41ETr (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: 1110 Broadway PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Williams Investments TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1020 W Casino Rd <br /> — Everett STATE WA zip 98204-2098 <br /> OWNER PHONE: 425.355.0353 OWNER EMAIL: ryan@williamsinvest.com <br /> CONTRACTOR NAME: Mibre Plumbing <br /> CONTRACTOR ADDRESS: STREET 34 Chick Rd <br /> CITY Camano Island STATE WA zip 98282-8724 <br /> CONTRACTOR PHONE: 360.840.7268 CONTRACTOR EMAIL: mibreplumbing@wavecable.com <br /> CONTRACTOR LICENSE#(REQUIRED): MIBREP*905PN I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 050890 <br /> PRIMARY CONTACT: M OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 360.840.7268 <br /> Mike CONTACT EMAIL: mibreplumbing@wavecable.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Vacant Contract Price of Work:$ 38 100.00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ISCommercial ❑Industrial <br /> Type of Project: ❑New [RAddition ®Remodel ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> Remodel&Addition <br /> ASSOCIATED BUILDING PERMIT# if applicable): B1606-074 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: New _X_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 6 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 8 Lavatory(Wash Basin) 1 Drinking Fountain <br /> Water Heater Refrigeration Shower I Floor Drain <br /> Gas Fireplace Wood Stove 1 lKiltchen Sink&Disposal I Grease Trap <br /> Gas Ran ge Ducting Dishwasher 4 1 Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 1 Water Heater 1 Other: Mop Sink <br /> Exhaust Fan 2 Sink(Service/Bar/Mop/etc.) 1 Other: Refrigerator Box <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 1 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 /> Ntj�"4k <br /> PERMIT# <br /> 09.13.16 zvvct <br /> Owner/Tt <br /> horized A t <br /> Signa Date (Revised 5/20/2 16) <br />