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PERMIT APPLICATION <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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black ink Only Please) PROJECT-SITE INFORMATION <br /> PROJECT SITE ADDRESS: 11419 19th Ave. SE, C106 Everett, WA 98208 PROPERTY TAX#: 2897190 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION tt1'Vh <br /> OWNER NAME: Washington Building Supplies LLC TENANT NAME(If Commercial): Silverlake Clinic <br /> OWNER MAILING ADDRESS: STREET 11419 19th Ave SE, C106 <br /> CRY Everett STATE WA ZIP 98208 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Western States Fire Protection <br /> CONTRACTOR ADDRESS: STREET 14690 NE 95th St. Unit 101 <br /> cry Redmond STATE WA ZIP 98052 <br /> CONTRACTOR PHONE: 425.881.0100 CONTRACTOR EMAIL: samantha.villarreal@wsfp.us <br /> CONTRACTOR LICENSE#(REQUIRED): WESTESFI 36QF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):20553 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206.771.4294 <br /> Samantha Villarreal CONTACT EMAIL: samantha.villarreal@ <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building:Vacant Contract Price of Work: ., <br /> Proposed Use of Building:Silverlake Clinic (Acupuncture) Heat Source: ❑Gas •Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: IIRCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign pSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Add and relocate sprinklers for new tenant buildout. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 81803-026 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 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/SUPPR SION S STEM <br /> Chemical ol`Water ) 4 IN..of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application.nd 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. anting of a pe it only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized u der any circ stance.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 comply with the State Contractors La 18.27 W and 296.200A WAC. <br /> City of Everett Official Use Only <br /> firArA2- tPA / I D 00 <br /> Own-�, uthorized Agent Signature Date (Revis d 9/23/2016) <br />