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PERMIT APPLICATIO" <br /> ellilh <br /> BUILDIN( /IECHANICAL / PLUMBING / SIGN DRINKLER / DEMOLITION <br /> '40 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2211 West Casino Road Everett, WA 98204 PROPERTY TAX#: 28041400200900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: FLAKE DAVID & MARCIA TENANT NAME (If Commercial): ACCcSS Cc:..(t,— <br /> OWNER MAILING ADDRESS: STREET 10704 64TH PL W <br /> CITY MUKILTEO STATE WA ZIP 98275 <br /> OWNER PHONE: N/A OWNER EMAIL: N/A <br /> CONTRACTOR NAME: Reliance Fire Protection <br /> CONTRACTOR ADDRESS: STREET 8168 304th Ave SE PO Box 428 <br /> CITY Preston STATE WA ZIP 98050 -0428 <br /> CONTRACTOR PHONE: (206) 682-6636 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): RELIAFP102L1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 031095 <br /> PRIMARY CONTACT: ElOWNER • CONTRACTOR ❑ OTHER (Please Specify) (.,----- - <br /> CONTACT NAME: Oleg Sergeev CONTACT PHONE: (206) 682-6636 <br /> CONTACT EMAIL: oleg@reliancefire.com <br /> BUILDING PERMIT APPLICATION,„--! <br /> Existing Use of Building: Contract Price of W rk: $ r.31-"coo <br /> Proposed Use of Building: Heat Source: ❑Gas Electri LJOther <br /> Building Type: ❑SFR-Detached ESFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /e ,Ait� il'e 'G <br /> cc4 -�k ,. F-/c & p?c-�'�� it" ay"J k t7 r - <br /> • Azt,4`4,/y e-e/j/V <br /> +v-e if f -l4 f t ,4-et,) e e'Y_4 L7 -L- 44- 42, 49" a <br /> ASSOCIATED BUILDING PERMIT#(if applicable): !� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New y Addn y Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-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/ SUPPRION SYSTEM <br /> Chemical or Nater 153 iNo. of Heads <br /> ACKNOWLEDGEMENT:I have reviewe this appfcation 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 g tiring of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,--j <br /> City of Everett Official Use Only <br /> / P \goA —CC3 <br /> b__ <br /> / 3aoi8 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />