1519 132ND ST SE DENTISTS OF MILL CREEK PACIFIC DENTAL 2019-08-20

PERMIT APPLICATIO" BUILDIN( _ AECHANICAL/ PLUMBING / SIGN I �PRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES � 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 � FAX 425-257-5857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 151 9 13ZnCI St. SE, Suite G & H PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Debora Robertson TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer ciTv STATE ziP 92614 OWNER PHONE: 425-417-1 O77 OWNER EMAIL: debora.robertson@live.com CONTRACTOR NAME: tbd �y�, � � ' � CONTRACTOR ADDRESS: sTREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�' 1 PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR � OTHER(Please Specify) Tenant CONTACT NAME: CONTACT PHONE: g51-582-5758 Brandon Webb CONTACT EMAIL:�rebbb@pacden.com BUILDING PERMIT APPLICATION �r�-_. �_.$ Existing Use of Building: Retail Contract Price of Work: $ 18,432 mech 28 lumb Proposed Use of Building: Dental Office Heat Source: �Gas ❑Electric ❑ ther Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 1C7Com ercial ❑Industrial �` Type of Project: ❑New ❑Addition ❑Remodel ❑Repair �T.I. ❑Sign ❑Sprinkler �Demolition jl7C nf.Llse--"'�� DESCRIPTION OF WORK: Mechanical distribution ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn ,�Alteration _Repair Type of Project: _New _Addn ,LAlteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units HearPump 2 Toilet � Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler z Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace- Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range ves Ducting Dishwasher Roof Drains Clotries Dryer Hookups Other: 1 Clothes Washer Medical Gas �2ange Hood Other: s Exhaust Fan a Sink (Service/Bar/Mop/etc.) Other: SPRINKLER I SUPPRESSION SYSTEM . Number of Heads ACKNOWLEDGEMENT:1 have reviewed this application and confinn the information contained herein is true and correct. Work done pursuant to thrs permit must comply with 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 Building Official before being authorized under any circumstance. 1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. Ciry of Everett Official Use Onty PER IT# � � O �- o� S Owner/Authorized Agent Signature Date evised 9/23/2016)