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PERMIT APPLICATIOI'� <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 425-257-5857 �(E)everetteps@evereriwa.gov� www.everettwa.gov/permits <br /> (Blue`or.�lack ink On1y=Please) <PROJE�T;SI?E'iNFORMATi�N -° <br /> PROJECT SITE ADDRESS: 1331 112th St.SE Everett,WA 98208 PROPERTY TAX#: 28051900401300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> '_CONTACT INFOR,a AT1�N <br /> OWNER NAME: Freewa Center LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer 1501 N. 200t11 St <br /> c�n Shoreline sTATE WA ziP 98133 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'j� <br /> CONTRACTOR ADDRESS: sTReer <br /> � CITY � STATE ZIP � <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) ,Agerit fOT'T-MOblle <br /> CONTACT NAME: CONTACT PHONE: g58-964-7430 <br /> Kathleen Doan-Ha CONTACT EMAIL: kdoanha@ m � .com <br /> �..., :��,... . ` $l;l1L����P�RMI'i`�PPI.rC>A'�'ION ';' <br /> Existin Use of Buildin : Unmanned telecommunications facilit Contraet Priee of Wor .$ 25 000 <br /> Proposed Use of Building:Unmanned telecommunications facility Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil �of Units: �Commercial ❑Industrial <br /> Type of Pro'ect: ❑New �Addition ❑Remodel �Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replace(3)TMAs with(3)style 3C TMA's.Replace(2) FXFB's with(3) FHFB's. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION ` PLUMBING PERMIT APPLICATION' `' ' <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repafr <br /> #of List of Fixtures #of V y,�of Fixtures #of (,Ist of Fixtures #of List of Fixfures <br /> Fi�ctures Fixtures Fixfures Fixtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and con�rm 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�rst be authorized in writing irom the <br /> Building O�cial 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 I comply with the State Contractors Law 18.27 RCW and 296.200A.WAC. <br /> City of Everett Official Use Only <br /> „s'''`.." 5 �Z4��1 PE I # �^A� ��� <br /> �\.J <br /> Owner uthorized Agent Sig re Date (Revised 9/23/2016) <br /> �� <br />