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� � PERMIT APPLICATIOh � <br /> BUILDING � ECHANICAL / PLUMBING / SIGN , :: RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � <br /> �r'"✓ 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 25-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1519 132nd St. SE, Suite G & H PROPERTY TAX#: <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �eb0�a RObe�tSOfl TENANT NAME(If Commercial): TB� <br /> OWNER MAILING ADDRESS: srReEr <br /> CITY STATE ZIP <br /> OWNER PHONE: 425-41 7-1 O77 OWNER EMAIL: debora.robertson�a live.com <br /> CONTRACTOR NAME: tbCl � ��� <br /> ONTRACTOR ADDRESS: sTReET \ � � �' I�� S ��I � � <br /> CITY �J�� � e STATE �� ZIP l <br /> CONTRACTOR PHONE: - �jl� ' � CONTRACTOR EMAIL: �i. �y�lS�(� W 1 CL G'�� � ��S � L� J`�, <br /> ONTRACTOR LICENSE#(REQUIRED):'� " �L.�j� �( �� �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � C � <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 8 OTHER(Please Specify) Tenant 7� C� 1 <br /> CONTACT NAME: CONTACT PHONE: g51-582-5758 <br /> Brandon Webb CONTACT EMAIL:WebbbQa paCden.Com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Retail Contract Price of Work: $85,461.00 <br /> Proposed Use of Building: Dental Office Heat Source: �Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attacned ❑Duplex ❑Multi-Family-#of Units: lC7Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair �T.I. ❑Sign ❑Sprinkler �Demolition �L1Change of Use <br /> DESCRIPTION OF WORK: <br /> Non structural partitions, lights, outlets, switches, sinks, two restrooms, mechanical distribution, acoustic ceiling <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _RepaiL-"' <br /> #of #of #of #of - '` <br /> List of Fixtures List of F" ures List of Fi�ures LisYof Fixtures <br /> Fi�ures Fixfures � Fixtures Fi�rtures <br /> A/C—Air Handling Units He��-Pump z Toilet � B�ef<�low Preventer(Inside Bldg) <br /> Forced Air Systems nit Heater Bathtub >�` Urinal <br /> Gas Piping �! Boiler z Lavatory(Wash Basin) Drinking Fountain <br /> electric Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dis sal Grease Trap <br /> Gas Range Ducting Dishwasher �' Roof Drains <br /> Clothes Drye ookups Other: � Clothes V��sher Medical Gas <br /> Range d �e�ec Waterf=leater Other: <br /> Ex st Fan 4 S� (Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM � <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comp/y 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 unde�any circumstance. 1 am the owner,or 1 am authorized by the owner of this property to perform the work for which applrcation is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM � <br /> 1� � � O - 02 � � �- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />