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,fie I PERMIT APPLICAM <br /> 0,,, ;"""" BUILIANG/MECHANICAL/PLUMBING/SIG1V ) SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: 2015 Lake Heights Dr. S.E. PROPERTY TAX#: 28052900205200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 31 .. V...x .g e\r ..x... f:ii�sF,�,. „ �,. - a7k44 ,.:<n,,,,,,, .X 3 ., _ .. 010* 7,1s_g <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 6 8th Ave . S. - 1 <br /> CITY Kent STATE WA ZIP 98032 I <br /> CONTRACTOR PHONE: 425-633-0663 CONTRACTOR EMAIL: TLambro@interstaterestoration,corn <br /> �_� <br /> CONTRACTOR LICENSE#(REQUIRED): INTERRW905BH ;CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <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 /> r51iiiiiiirr .,. .,//,5 .., ...., "xis .. « #.... .. ......r. ,.a, .. <br /> Existing Use of Building: Senior Living Facility Contract Price of Work:$ 50, 000 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin. T pe: ❑SFR-Detached ❑SFR-Attached ❑Du•lex *Multi-Famil -#of Units: 46 ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel In Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Pre-Application Consultation (Inspection) for the purpose of <br /> I <br /> getting a permit for repair (for a vehicle impact) . <br /> 1' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): o_ 1 <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: _ New _Addn Alteration Repair j <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> #of #of #of #of <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units —Heat Pump TR-Attach - Preventer(Inside Bldg) <br /> Forced Air Systems —Unit Heater Bathtub Urinal f <br /> r�� <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 Ductin ; Dishwasher Roof Drains — i <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran.e Hood Water Heater Other: 1j <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> Chemical or Water No.of Heads i <br /> ®�® <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 rrom Ma <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 /> PERMIT# .Oa1-11 <br /> 8/8/17 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />