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PERMIT APPLICATION■ <br /> BUILDING/MECHANICAL <br /> I PLUMBING I SIGN I.SPRINKLER/DEMOLITION <br /> #40✓/''''�` 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 1 www.everettwa.gov/permits <br /> (Blue or Black.Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2722 Colby Ave . PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Umpqua Bank TENANT NAME(If Commercial): Umpqua Bank <br /> OWNER MAILING ADDRESS: STREET 707 West Main Ave Suite 450 <br /> CITY Spokane STATE WA ZIP 99201 <br /> OWNER PHONE: 503.327.2761 OWNER EMAIL: ELLABEHNOUD@UMPQUABANK.COM <br /> CONTRACTOR NAME: Mibre Plumbing <br /> CONTRACTOR ADDRESS: STREET 34 Chick Rd <br /> CITY Camano Island STATE WA - ZIP 98282 <br /> CONTRACTOR PHONE: 509.306.0266 CONTRACTOR EMAIL: Nate@Mibre2010.com <br /> CONTRACTOR LICENSE#(REQUIRED): MIBREP*905PN CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 50890 <br /> PRIMARY CONTACT: ❑OWNER I CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 509.306.0266 <br /> Nate Slattery CONTACT EMAIL: Nate@Mibre2010.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Bank Contract Price of Work:$ 4,492.00 <br /> Proposed Use of Building: same Heat Source: OGas pi Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: E21Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ods <br /> _ — $,retlaNroow\ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Q` o( —w <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: a!�_Nev 1 Addn Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of 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 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups .Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater I Other: Corer wider <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 No.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 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 /> City of Everett Official Use Only <br /> PE IT# <br /> • <br /> �. 03.14.19 k O _ `1 <br /> Owner/Authorized V gen '•-f ure Date (Revised 9/23/2016) <br />