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MN • PERMIT APPLICATION • <br /> In <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ 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:252SRucker Ave PROPERTY TAX#:00562456001000,005624560C <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT BUSINESS NAME(Commercial): Salvation Army <br /> OWNER MAILING ADDIES : STREET 2525 Rucker Ave <br /> ciT,. Everett STATE WA ZIP 98201 <br /> OWNER PHON OWNER EMAIL:Andrea.Reedy@usw.salvationarmy.org <br /> CONTRACTOR ME:TBD '( O\ow II CM <br /> CONTRACTOR/ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) O V ✓x <br /> II V ut b t)(1) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE:(425) 252-2153 <br /> Danielle Fowler-2812 architecture CONTACT EMAIL:danielle@28 iteC re.com 1 DMZ) <br /> BUILDING INFORMATION , <br /> Existing Use of Building:Community service (A3, B,) :Contract Price f Work: $20,000 /` <br /> Proposed Use of Building: Community service (A3, B,) Heat Source: Gas ❑Electric Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Un s: Etc ercial ❑Accessory Structure <br /> Type of Project: New Addition Remodel Repair ❑✓T.I. Sign emolition ❑Change of Use <br /> DESCRIPTION OF WORK: Remodel existing restrooms to meet ADA requirements. Provide new finishes throughout. <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 /> A/C—Air Handling Units Gas Piping Backflow 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 Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil 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 No.of Heads <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,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 comp h the State Contractors Law 18.27 RCW d 296.200A WAC. <br /> �f•� City of Everett Official Use Only <br /> oosi ' l JvnC Zd/T PERNI!+ ,0(c. 0�� <br /> Owner/Authorize Agent Si ature Date (Revisedl1`0�/110/2018) <br /> 1/2Z <br />