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El <br />PERMIT APPLICATIOe <br />BUILDINAECHANICAL / PLUMBING / SIGNWPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />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) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 14 E CASINO ROAD, EVERETT, WA 98208 <br />PROPERTY TAX #: 28041300105301 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: CHILDSTRIVE TENANT BUSINESS NAME (Commercial): CASINO ROAD INITIATIVE <br />OWNER MAILING ADDRESS: STREET 14 E. CASINO ROAD, BLDG. C <br />CIT, EVERETT STATE WA ziP 98208 <br />OWNER PHONE: 425-353-5656 <br />OWNER EMAIL: Jim.welsh@childstrive.org <br />CONTRACTOR NAME: TO BE DETERMINED <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 0 OTHER (Please Specify) ARCHITECT <br />CONTACT NAME: <br />MARKUS BARRERA-KOLB <br />CONTACT PHONE: 206-787-1381 <br />CONTACT EMAIL: MBarrera-Kolb@eworks.org <br />BUILDING INFORMATION <br />Existing Use of Building: OFFICE/ASSEMBLY <br />Contract Price of Work: $ 4J-0- a` G 24 <br />Proposed Use of Building: OFFICE/ASSEMBLY <br />Heat Source: ❑Gas I]Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓ T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: TENANT IMPROVEMENT OF AN EXISTING OFFICE BUILDING AND MODIFICATIONS OF <br />EXISTING COURTYARD <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />Li Fixtures <br />A/C — Air Handling Units <br />G Piping <br />Backflow Preventer (Inside Bldg) <br />ShoAoerTub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Ink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Reside al) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (T I) <br />Hose Bibb <br />Urinal <br />Exhaust Hoo ype II) <br />Water Heater <br />Interceptor- se <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Intercep r-Sand/Oil <br />Water Service (behind meter) <br />Forc 'Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />s Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />PRINKLER / SUPPRESSION <br />SYSTEM------ <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. 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 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 />PERTn l/ <br />ent Signature Date` ►► (Revised 1011012018) <br />� �rl ��,� �� � i �I V ► �UI�M;�II T,q� ���� � Jz <br />