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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS:11632 Evergreen Way, Everett, WA, 98204 PROPERTY TAX# I rr-R--cD LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal descriptin) <br /> OWNER J PC LLC Phone/E-mail 360-589-1761/farmerco-op@outlook.corn <br /> Address2020 SE Division St, Portland, OR, 97202 city/State/zip Portland, OR, 97202 <br /> APPLICANT:_Owner _Owner's Agent ✓ Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner t.,•work in the space) <br /> CONTRACTOR Columbia Fire L&I Lic.# COLUMFI952MG COE B s. Lic.#04b2-Y\ <br /> Address 111 S Findlay St, Seattle , WA, 98108 Phone/Email 206-232-8569/peters. : ••.'. ' - .- <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Domino's Pizza Phone/E-mail 206-232-8569/ peters@columbiafire.net <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 5,400.00 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family ✓_Commercial <br /> Type of project: _New T Addition Remodel Repair_T.I._Sign ✓ Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ADD AND RELOCATE (22) PENDENT QR SPRINKLERS TO RESTORE COVERAGE AT REMODELED WALLS AND <br /> CEILINGS <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> __ Other _ Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> 22 Number of Heads Other: <br /> I hereb certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with•heth: specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> T :t I am 1uth•rized by the ower of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � - .�V 10/10/2017 <br /> : er/Authorized ,gent Signature Date (Revised 6/2012) <br />