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PERMIT APPLICATION <br /> /11111P/0/11:1*,/-----4 <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> ..411 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: 2015 Lake Heights Dr. ,,5- . PROPERTY TAX#: 28052900205200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Brookdale LLC c/o Randy MaglioTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6737 W. Washington St . , #2300 <br /> cITY Milwaukee STATE WI ZIP 53214 <br /> OWNER PHONE: 206-402-2352 OWNER EMAIL: rmaglio@brookdale.com <br /> CONTRACTOR NAME:Interstate Restoration - Telly Lambro <br /> CONTRACTOR ADDRESS: STREET 22342 68th Ave. S. <br /> cin Kent STATE WA ZIP 98032 <br /> CONTRACTOR PHONE: 425-633-0663 CONTRACTOR EMAIL: TLambro@interstaterestor 'en.cr ff <br /> CONTRACTOR LICENSE#(REQUIRED): INTERRW905BH CITY OF EVERETT BUSINESS LICENSE#(REQUIR D): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ®OTHER(Please Specify) Owner' s Agent <br /> CONTACT NAME: Chris Bacus CONTACT PHONE: 206-281-7500 <br /> Pacific Engineering Tech. CONTACT EMAIL: cbacus@pacengtech.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Senior Living Facility Contract Price of Work:$ 50, 000 <br /> Proposed Use of Building: Heat Source: ❑Gas 1:1 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ['Duplex ►N Multi-Family-#of Units: 4 6 ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ®Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Vehicle Impact Repair to an existing Senior Living Facility <br /> (Brookdale - Silver Lake) <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 -.air <br /> #of List of Fixtures #of List of ' ures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Pump Toilet -ckflow 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&Disp.:. Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Ho. ups Other: Clothes Wa •-r Medical Gas <br /> Range Hood Water H:: er Other: <br /> Exhaust Fa Sink =ervice/Bar/Mop/etc.) Other: <br /> SPRI ER/SUPPRESSION SYSTEM <br /> 'Chemical or Water I INo.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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> (City of Everett Official Use <br /> �Only ,, <br /> �• 8/9/17 <br /> PER . . V��L <br /> Owner/AuthorizedU` IT�k \Agent Signature Date (Revised9/23/2016) <br />