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PERMIT APPLICATION <br /> BUILDINCIEII/ PLUMBING / SIGN RINKLER/ DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:4933 Evergreen Way Everette,WA 98203 PROPERTY TAX#:00581900000101 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Claremont Village Station LLC TENANT BUSINESS NAME(Commercial): Vera for City of Everett <br /> OWNER MAILING ADDRESS: STREET 11501 Northlake Dr <br /> cin. Cincinnati STATE OH zip 45249 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:Swinerton Buildiers <br /> CONTRACTOR ADDRESS: sTREET 14432 SE Eastgate Way,Suite 230 <br /> CITY Bellevue STATE WA ZIP 98007 <br /> CONTRACTOR PHONE: 425.283.5252 CONTRACTOR EMAIL: 425.283.5252 <br /> CONTRACTOR LICENSE#(REQUIRED):SWINEB*992DR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 53985 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE:1 (206)576 1657 <br /> Bridget Snider CONTACT EMAIL:Pridgets@anl,ii4Oison.c <br /> BUILDING INFORMATION <br /> Existing Use of Building:Retail Contract Price of W k:$740,552 <br /> Proposed Use of Building:Clinic Heat Source: OG s ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: J✓ mercial ❑Accessory Structure <br /> Type of Project: ❑New EAddition ERemodel El Repair ❑✓T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: A 3,771 SQ.FT. TI CONVERTING AN 'M'OCCUPANCY(RETAIL) SPACE INTO A'B' OCCUPANCY <br /> (CLINIC). STRUCTURAL ELEMENTS TO REMAIN AS IS. TENANT SEPARATION PARTITION TO REMAIN AS IS. <br /> STOREFRONT ENTRY TO BE REPLACED AND BACK DELIVERY DOOR TO BE INFILLED. ALL NEW INTERIOR SPACE. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Demo Permit- B1908-025 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count " List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 /> PER # <br /> / Jo 9' n -03(0 <br /> 3(0 <br /> Owner/Authorize gent Signature Date (Revised 10/10/2018) ~, <br />