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11111 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> EVERETT CITY 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: 2915 Pine Street PROPERTY TAX#:00593669501300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Kaiser Permanente TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREET2715 Naches Ave SW <br /> CITY Renton STATE WA zip 98057 <br /> OWNER PHONE:206-630-3905 OWNER EMAIL: Iauren.a.hilger@kp.org <br /> CONTRACTOR NAME: NorthStar CG, LP <br /> CONTRACTOR ADDRESS: STREET8160 304th Ave SE <br /> my Issaquah STATE WA ZIP 98027 <br /> CONTRACTOR PHONE: 425-881-0623 CONTRACTOR EMAIL:jSChuster@northstar.com <br /> CONTRACTOR LICENSE#(REQUIRED): narthc1852jc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 44505 <br /> PRIMARY CONTACT: D OWNER CI CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-510-2594 <br /> John Schuster CONTACT EMAIL:jschuster@northstar.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:abandOn Contract Price of Work:$37k <br /> Proposed Use of Building: demo Heat Source: OGas DElectric DOther <br /> BUILDING USE: ®SFR CJTownhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair L]T.I. OSign Sprinkler IZ]Demolition LiChange of Use <br /> DESCRIPTION OF WORK: building being levelled. <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <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 /> ANC—Air Handling Units Gas Piping Backfiow 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 Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Flood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential), Wood Stove InterceptorSand/OII 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 jNo.of leads <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,stele,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.l am the owner,Cr!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 /> Cie <br /> City of Everett Official Use <br /> 'oOnly <br /> Onnll y� <br /> `L-1 ).,.; :� PE ;:0.�`� ` cog <br /> Owner/Autho d Agerit°Signature.. gate (Revised 10/10/2018) <br /> k <br />