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0 19A, A <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />4W7-T 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PR CT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1 122 75th Street SW, V ett, WA 98203 <br />PROPERTY TAX #: 28041200305000 <br />LEGAL for new construction: Short Plat/subdivision 9311050036 Lot No. 3 (attach copy of long legal description) see Title Sheet <br />CONTACT INFORMATION <br />OWNER NAME: Snohomish Public Utility District No. 1 TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 2320 California Street <br />CITY Everett STATE WA ZIP 98201 <br />OWNER PHONE: 425-783-8545 <br />1OWNEIR EMAIL: Robert Reed - rbreed sno ud.com <br />CONTRACTOR NAME TBD <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ® OTHER (Please Specify) Architect <br />CONTACT NAME: <br />Sharon Robinson, Zervas GroupArchitects <br />CONTACT PHONE: 360-734-4744 <br />CONTACT EMAIL: sharon@zervasgroup.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: A-3 Church <br />Contract Price of Work: $ <br />Proposed Use of Building: no change <br />Heat Source: ®Gas ®Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi -Family-# of Units: ®Commercial ❑Industrial <br />Type of Project: ❑New, ❑Addition ®Remodel ®Repair ❑T.I. ❑Sign ®Sprinkler ®Demolition Change of Use <br />DESCRIPTION OF WORK: <br />Phase One - envelope maintenance and roof repair. Modification to fire alarm and suppression systems, building access control, and <br />preliminary interior demolition. Building will not be occupied until end of Phase Two. Site work to include pavement repairs, lighting. security, <br />and new access controls for existing gates. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn X Alteration <br />_Repair <br />Type of Project: _New _Addn <br />_Alteration _Repair <br />#of <br />Fixtures <br />t <br />List of Fixtures <br />#of <br />Fixtures <br />List of Fixtures <br />#of <br />Fixtures <br />List of Frxtures <br />#of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air,Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />l <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />I <br />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 1 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 />PERMIT # <br />03/05/2018 <br />Date (Revised 912312016) <br />L Z- <br />