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PERMIT APPLICATION
<br /> BUILDING / MECHANICAL 1 PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: ERTY TAX#: 28041400301000,28041400301000
<br /> LEGAL for new construction: Short Plabsubdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: BO@Illg (Building 45-80) TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReeT 3003 W Casino Rd, Everett 98204
<br /> ��TM Everett STATE WA Z�P g8204
<br /> OWNER PHONE: 206-4'07-26�4 OWNER EMAIL: peC'CT11tS G�CY18C�'Y11IIet'.COCTI
<br /> coNTwacroR NaMe; MacDonald Miller
<br /> CONTRACTOR ADDRESS: sTReer 7717 Detroit Ave SW
<br /> �,n Seattle STA� WA Z,P 98106
<br /> CONTRACTOR PHONE: ZO6-4O7-26'I4 CONTRACTOR EMAIL: @1'PY11tS macmiller.com
<br /> CONTRACTOR LICENSE#(REQUIRED): MACDOFS9HORU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O4O6BrJ
<br /> PRIMARY CONTACT: ❑OWNER L�CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ZO6-4O7-26'I4
<br /> Joyce Copley coNracr ennai�: joyce.copley@macmiller.com
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<br /> Existin Use of Buildin : Ma11UfaCtUPIIIg Contract Price of Work:$ 3 ��
<br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other
<br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: I,�Commercial ❑Industrial
<br /> T e of Pro'ect: ❑New �Addition �Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> Replacing qty (12) existing drinking fountains with new ones in same locations
<br /> ASSOCIATED BUILDING PERMIT# if a licable:
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<br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New Addn �,Alteration _Repair
<br /> #of /ast of Fixtures #of Vy,�of Fixtures #of ust of FixWres #of List of Fixtures
<br /> Fixtures Fiutures Fixfures Fixiures
<br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld )
<br /> Forced Air S stems Unit Heater Bathtub Urinal
<br /> Gas Pipin Boiler Lavato Wash Basin 12 Drinkin Fountain
<br /> Water Heater Refri eration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra
<br /> Gas Ran e Ductin Dishwasher Roof Drains
<br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other:
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<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 comp/y with
<br /> current federal,state,and/ocal 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 Officia/before being authorized under any circumstance.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply wrth the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> �^ �� # City of Everett O�cia/Use Only
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<br /> 12/7/2016 � C 2,_,.�` �
<br /> Owner/Authorized Agent Signature Date (Revised�20/2016)
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