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OLT PERMIT APPLICATIO <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SORINKLER/ 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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 10530 19TH AVE SE PROPERTY TAX#: 28051900104500 <br /> LEGAL for new construction: Short Plat/subdivision SECTION 19 TOWNSHIP 28 RANGE 5 QUARTER NE LOT 2 TGW 50% INT TR 999 <br /> -OF KEPPLER BSP 006-04 REC AFN 200501275002 BEING A PTN OF SE 1/4 NE1/4 <br /> CONTACT INFORMATION <br /> OWNER NAME: Opus Bank TENANT NAME(If Commercial): Opus Bank <br /> OWNER MAILING ADDRESS: STREET 19900 MacArthur Blvd., 121h Floor <br /> CITY Irvine STATE CA ZIP 92612 <br /> OWNER PHONE: (425) 258-0616 OWNER EMAIL: Jack Albright/JAlbright@opusbank.com <br /> CONTRACTOR NAME: T- -eo petitive-bid> _ (c C t,,,.-r&CCya5,(1 <br /> CONTRACTOR ADDRESS: STREET nc,k3(i, L LA\A c- & , ( J - J i— <br /> CITY ak ib �� STATE ZIP C,/( S 5 <br /> CONTRACTOR PHONE: 20Co I 7 ot$9 CONTRACTOR EMAIL: - `- l <br /> 2/ <br /> CONTRACTOR LICENSE#(REQUIRED):� C.C.,C O(TC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) (�/ [ �I <br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR IXI OTHER(Please Specify) architect \ Li )3 , I <br /> CONTACT NAME: Jessica Bradley CONTACT PHONE: (206) 720-7001 �� <br /> Craft Architects CONTACT EMAIL: Jessica@craftarchitects.com I <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: OFFICE Contract Price of Work: $ 30,000 <br /> Proposed Use of Building: to remain B-office Heat Source: DGas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ECommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair ET.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> TENANT ALTERATION CONSISTING OF: NON-STRUCTUAL RENOVATION OF EXISTING OFFICE SPACE. <br /> ehtsik‘..6i.t.i 9— <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number 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/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 o(f Everett Official Use Only PEtt <br /> OL '+'S k k <br /> Owner/A ized Agent gnature Date (Revised 10/12/2015) <br /> iiz___ <br />