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PERMIT APPLICATION <br />wn BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINQTON (P) 425-257-8810 i FAX 425-257-8857 l (E) everetteps@everattwa.gov I www.everattwa.gov/permits <br />tirGlue or Black Ink Only Pleas*) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 2917 Pacific Ave <br />1PROPERTY TAX #:00439069505001 <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 />c,Tv Renton sTATE WA zia 98057 <br />OWNER PHONE: 206-630-3905 <br />OWNER EMAIL: lauren.a.hilger@kp.org <br />CONTRACTOR NAME: NorthStar CG, LP <br />CONTRACTOR ADDRESS: STReET6160 304th Ave SE <br />ciry Issaquah srATE WA z,, 98027 <br />CONTRACTOR PHONE: 425-881-0623 <br />1CONTRACTOR EMAIL:jschuster@northstar.com <br />CONTRACTOR LICENSE #(REQUIRED): northcI852jC <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 44505 <br />PRIMARY CONTACT: ❑ OWNER El CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />John Schuster <br />CONTACT PHONE: 206-510-2594 <br />ICONTACT EMAIL: jschuster@northstar.com <br />BUILDING INFORMATION <br />Existin Use of Building:abandon <br />I Contract Price of Work: $ 85k <br />Proposed Use of Building: demo <br />Heat Source: ❑Gas 0Electric OOther <br />BUILDING USE: ©SFR ❑Townhouse ❑Du lex ❑ADU []Multi -Family- # Units: ❑Commercial ❑Accessory Structure <br />Type of Proect: ❑New ❑Addition ❑Remodel ❑Repair 0T.L ❑Sin OS rinkier ®Demolition ❑Chan a of Use <br />DESCRIPTION OF WORK: building being levelled. <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />FWom <br />Count <br />list of Fixtures <br />F&Wra <br />count <br />LJsi of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />11st of Fixtures <br />A/C —Air Handling Units <br />Gas Piping <br />Backhow Proverter Inside Bldg <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Gothes Washer <br />Sink -Commercial 3-com ,pre,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-Utillty, laundry, mop <br />Exhaust Fans Residential <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type l <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type ii <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood Residential <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplacelinsert/Log <br />I <br />Roof Drains <br />Water Heater <br />SPRINKLER J SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression gystem <br />No. of Heads <br />Chemical suppression 5ystem <br />INo. ot Heads <br />ACKNOWLEDGEMENT: i have reviewed this application and mmrifirm the infatuation contained harem Is true and cmred. 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 />Buliding Offksial before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this pfoparty to perform the work for which application is made, <br />and/ comply with the State Contractors Law 18.27 RCW and 298.200A WAC, <br />`- City of Everett Official Use ONy <br />PE # <br />Owner/Authors d gent ftagluire Date Revis OI1012018 <br />