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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> 14[77 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> f` PROJECT RITE,INFORMATION , <br /> PROJECT SITE ADDRESS: 3003 W Casino Rd. PROPERTY TAX#: 280415000100100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION, <br /> OWNER NAME: Boeing Co TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PO Box 3707 M/S OH-13 <br /> cn v Seattle STATE WA ZIP 98124-2207 <br /> OWNER PHONE: 425-260-2668 OWNER EMAIL: todd.j.haberlack@@boeing.com <br /> CONTRACTOR NAME: TBD-The contract is out for bid <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): TBD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): TBD <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-260-2668 <br /> Todd Haberlack CONTACT EMAIL: todd.j.haberlack@boeing.com <br /> .iagn , ,' v,., „ f, ,.\` 01,01:NGP,ERMItT APPLICATION ,; C .x,Z:4 3;.r.. <br /> Existing Use of Building: N/A Contract Price of Work:$44-27000 7w/ 7.1 4f2 <br /> • Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial I Industrial <br /> Type of Project: ONew ❑Addition ®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Access, demo and replace walls with plumbing fixtures. Minor reconfiguration of bathroom partion walls. <br /> i LQVD-37-, 1 Goy /13 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION `PLUMB,ING`PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alterati _Repair <br /> Fixtures List of Fixtures Fixtues List of Fi . es Fixtures List of Fixtures Fixtu es List of Fixtures <br /> A/C—Air Handling Units Heat P p Toilet ackflow Preventer(Inside Bldg) <br /> Forced Air Systems Un'. eater Bathtub Urinal <br /> Gas Piping -oiler Lavatory(Wash Basin) Drinking Fountain _ <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposa 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(Se . e/Bar/Mop/etc.) Other: <br /> • SPRINKLER.I 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 Offici- .efore being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I co ,ith the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (32._.,,,t/t <br /> 1�1 /7 P MIT# <br /> ( off -O�-t <br /> owner/Authorized ent Signature Date (Revised 10/12/2015) <br />