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- <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> B i**k,*lack irik OriIyr.'Please).,.... . .'.,PRO Ec 1 BSB INFORM 1ZI0N <br /> PROJECT SITE ADDRESS: 82 4 WEST CASINO ROAD ( t D6 4 A� PROPERTY TAX#: 00392100000700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) . <br /> OWNER NAME: TENANT NAME(If Commercial):CASINO-WESTMONT AFFORDABLE <br /> OWNER MAILING ADDRESS: STREET 2223. 112TH AVE. NE, SUITE 102 HOUSING PARTNERS, LLLP <br /> crry BELLEVUE STATE WA ZIP 98004 <br /> OWNER PHONE: 425-454-8205 OWNER EMAIL: COREY BALDWIN <br /> CONTRACTOR NAME: SRI-ROCHLIN CONSTRUCTION SERVICES JV, LLC <br /> CONTRACTOR ADDRESS: STREET 2223 112TH AVE. NE, SUITE 102 <br /> CITY BELLEVUE STATE WA ZIP 98004 <br /> CONTRACTOR PHONE: 425-681-6894 CONTRACTOR EMAIL: rochjimms@comcast.net <br /> CONTRACTOR LICENSE#(REQUIRED): ROCHLCS 8 9I PP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)a,1' <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 415-578-5562 <br /> TESSA LOMBARDI <br /> CONTACT EMAIL: t1ombardi@basisarch.corn <br /> ini.y.F: _ <,... .....:. . . ._ `BpIt.11j1N s-PER t tT APPLI ATJOV ...... . - <br /> Existing Use of Building: /9/p/.P41l Contract Price of Work:$_ '?gh/q 30 <br /> Proposed Use of Building: 'r Heat Source: IZIGas • DElectric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex 4Multi-Family-#of Units:_ SJ �:.ommercial [Industrial <br /> Type of Project: ONew DAddition ❑Remodel ❑Repair OT.I. OSign ❑Sprinkler ODemolition ®Change of Use <br /> DESCRIPTION OF WORK: <br /> BUILDING EXTERIORS: (N)FIBER-CEMENT SIDING WIHT CORRUGATED METAL ACCENTS, WINDOW REPLACEMENT, DRY ROT REPAIRS,FULL PAIIT <br /> AT EXTERIORS. <br /> INTERIORS:DRY WALL REPAIRS,PAINT,FLOORING, COUNTERTOPS, APPLIANCE AND FIXTURE REPLACEMENT. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ;e _-;1.111BBHANIC PERMItOptItCATI ON::S n':,; S ,,.. : ..P:4 BING'PBRMil'APPU TIOI+1;:I..x.. M` <br /> Type of Project: _New ^ Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f 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 /> INISsigigocglumfoostogostoivimg <br /> • Chemical or Water 1 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State C.C://c s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#/1-78(70A - t 3 11; <br /> Owner'•'thori •d Agent Signature Dat- (Revised 9/23/2016) <br />