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PERMIT APPLICATIO�
<br /> BUtI.DING i MECHANICAL! PLUMBING 1 SIGN 1 SPR[NKLER! DEMOLITi�N
<br /> CITY C}F EVERE7T PERMIT SERVICES
<br /> - 3200 CEDAR STREET,�VERETT,WA 9820�
<br /> ���;425-257-8810 j FAX 425-257-8857 �i��}i everetteps@everettwa.gov( wuvw.everettwa.govtpermits `
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<br /> PROJ�CT SITE At�DRESS• : _ __. r ROPER'7"Y TASt'#. -:
<br /> �3003 W Casino RD Everett,WA 98204 ; 280410001Q0200
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<br /> �:�GAL for new construction: Short PlaUsubdivision Lot No., (attach copy of long!egal description) �:.����
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<br /> �WNER NAM�;.. eoeing Everett (40-03 BLD) TENANT NAME(if Commercial):_
<br /> �WNER MAiLING ADDRESS: srnEEr 30Q3 W Casino RD Everett,WA 98204
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<br /> ��Ty Everett srnre WA ziP 98204
<br /> L7WNER PHONE: ' OWNER EMAIL:
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<br /> �ONTRACTOR NAME, MacDon.ald Miller
<br /> CONTRACTOR ADDRESS: STREET 7717 D2tCQit AV�..SW ,- - _ ':
<br /> _ cirv Seattle sraTE WA :ziP 98106 _
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<br /> �ONTRACTOR PHONE.„ ���}� 4Q7-2614 : CQNTRAC70R,EMA{�.: loyce.copley@macmiller.com �
<br /> G'ON7RACTQR LtCENSE#{32�Q,1lIRED): MACDOFS9$ORU ,C1TY dF EVERETT BUSINESS LICENSE#(�Cl�IfiE��t ������
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<br /> �'�tl�+t�' CONTACT: ❑OWNER �CONTRACTOR ❑QTHER(Piease Spec(fy}. <
<br /> �QNTACT NAME: ; CONTACT PHONE: Zd6-4�7-2��4 `
<br /> ' �O�/CL COpI@Y ; CONTAGT EMAlL: permifs a(_,7macmiller.corn
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<br /> Existin Use of Buildin : MEDICAL CENTER Contract Price of Warlt:,$_'�5oo.o0
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<br /> Pro osed Use of Buildin : �1EDICAL CENTER Heat Sa.urce: �Gas ,,,l��lectric DOther-
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<br /> Buildin T s: L7SFR-Detached ❑SFR-Attached C7Du lex ❑M.ulti-Famil -#of Units: �Commercial ❑Industriai '
<br /> �" �;ofP�'p�ect: �New ❑Addition ❑Remodei 0� ,���__. �TJ. C[�� r� ❑S. ;'nkler ❑Demoiition 0��"'� .ofUse
<br /> D��fi�1E�srtt�N c��waaKs _ _
<br /> Replacing qty (4) existing drinking tountains with new ones in same locations
<br /> �A�.S' �IA'T'ED BUILDING PERMIT# if�o-pp�i�aks��.' _, .... . ...
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<br /> ype of Project: _New _ Addn _X Alterat(on _Ftepair ; Type of Project: �New `Addn _,_,ANeratlon TRepair
<br /> , #o� #of `' `' #of:;: ; ;;; ;:.#of _: . ,.
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<br /> Fixtures List of Fixtures Fixfures : Llst af Flxtures i ptxtures; L/st of Flxtures :Flxtures ��st of Flxtures
<br /> A/C-�Air Handiin .Units ;Heat Pum ' oilet Backflpw,Preuenter(Inside Bld
<br /> Forced Air Sys(ams Unif Heafet' ' Bathtub , `Urinal " . '
<br /> Gas Pipin _ B:ol..ler ° Lavata .,.Wash 8asin; ;,�,' ;Drinkin Fou�ta'rtt" _
<br /> : Water''Heater ` Re.fri" eraClon 'Shawer Floor Drain
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<br /> _ Gas Fire lace Wood Stove ; Kitchen Sink&Dis osal Grease Tra
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<br /> Gas Rar� � Ductin ; Dishwasher Roofi Drains �
<br /> Clothes�1, ,��°l�i�'���p� . t�t�a�� VAV Clothes Washer Niedical Gas :
<br /> Ftan e Hoad :�' ���"""�t�r� ; .Watec:Fi�ater` t5fher: � ewash with val�res
<br /> Exhayst,�an �tilles ,�.-� `' Sink Servicel8�r/fvlo�tetc„ �CSther: F�fer�ox�Qnn�Gtians
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<br /> IVumber of Hea s _
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<br /> ACKNOWt.F_DG�MENT.•1 have rev/owQd thrs appifcafion and con�rm the tnformafion contalned herein is frue snd correct.Wak done pursuant to this permlt must compiy wtfh
<br /> current tederaf,state,and locsf law. The granting of a permit only�uthoHzes appraved work and no devlaflons therefrom.Devlatlnns rnusf f/rst be aufhalzed in wrifing from the
<br /> E3u!ldinc�dfrciei beforo befng authorized under any circumstence,i am fhe owner,or(txm authorized by the ownar of thls property to porform tha work iar which appliaation is made,
<br /> and 1 carriply wifh the St�te Contractnrs Law 18.27 RCW and 296.200A WAC.
<br /> Clty of E.veratt Offlctal Use Only
<br /> ��� C.-C.��J� PERM17 � "-� � �
<br /> �� 12/16/2016 �
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<br /> 4wnertAuthorized Agenk Signature: _ _ qate �lti'�L�,�s��:'1, 1i, �`�1�,�;`,
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