9900 12TH AVE W THE WINSLEY 2020-08-28

i 477- PERMIT APPLICATION BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET.EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:9900 12TH AVE WEST PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION /L)•f j'}')tV L,y OWNER NAME: TRU-AMERICA TENANT BUSINESS NAME(Commercial): WALDEN POND OWNER MAILING ADDRESS: STREET 1915 SECOND AVE 'flr\ W`i() )1-6t1\ cm, EVERETT STATE WA ZIP 98204 OWNER PHONE: 206-446-8803 OWNER EMAIL:SPACQUER@TRUAMERICA.COM CONTRACTOR NAME:KURKOV CONSTRUCTION COMPANY CONTRACTOR ADDRESS: STREET P.O. BOX 833 CITY GRAHAM STATE WA ZIP 98338 CONTRACTOR PHONE:206-549-9669 CONTRACTOR EMAIL:FEDOR@KURKOV.COM 4 CONTRACTOR LICENSE#(REQUIRED):VPJCOL*993J3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED: C) (---'s PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) AGENT CONTACT NAME: CONTACT PHONE:818-573-2484 LESLIE CAYTON CONTACT EMAIL:LCAYTON@PERMITPLACE.COM BUILDING INFORMATION Existing Use of Building:MULTI-FAMILY RESIDENTIAL Contract Price of Work: $200,000 Proposed Use of Building:NO CHANGE Heat Source: DGas ❑Electric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ✓❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ✓❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: TENANT IMPROVEMENT TO PUBLIC AREAS OF MULTI-FAMILY RESIDENTIAL BUILDING: ENLARGE (E) EXERCISE ROOM, ADD PACKAGE CONCIERGE AREA, UPGRADE FINISHES AND BATHROOMS, NO REDUCE 2ND FLOOR DECK, NO OTHER WORK OUTSIDE OF BLDG FOOTPRINT ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only ,,,,--,( er� L PERMIT# O2 0D5--- Owne horizecf gent Signature Date (Revised 10/ /2018) I l�