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< N PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> -J 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 1 www.everettwa.gov/permits <br /> tBiueorBlack Irk" lr Please) PM E T SITE INFORMATION A <br /> PROJECT SITE ADDRESS: 824 WEST CASINO ROAD ( t Det * 64 PROPERTY TAX#: 00392100000700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ONITACT I NFORMATION.. , <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 /> cry 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 /> car, BELLEVUE STATE WA ZIP 98004 <br /> CONTRACTOR PHONE: 425-681-6894 CONTRACTOR EMAIL: rochjimms@comcast.net <br /> CONTRACTOR LICENSE#(REQUIRED): ROCHLCS 8 9 IPP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 415-578-5562 <br /> TESSA LOMBARDI CONTACT EMAIL: t1ombardi@basisarch.com <br /> BUILDING PERiVtIT APPLI ,JITION ,. . <br /> Existing Use of Building: /f9f'/17416s4/T Contract Price of Work:$4 -1'6030 <br /> Proposed Use of Building: 'r Heat Source: ®Gas r7❑Electric ❑Other <br /> I1 <br /> Building Type: ❑SFR-Detached OSFR-Attached ❑Duplex Multi-Family-#of Units: YJ ._.:ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler CI Demolition ®Change of Use <br /> DESCRIPTION OF WORK: <br /> BUILDING EXTERIORS: (N)FIBER—CEMENT SIDING WIHT CORRUGATED METAL ACCENTS, WINDOW REPLACEMENT, DRY ROT REPAIRS,FULL PAIDT <br /> AT EXTERIORS. <br /> INTERIORS:DRY WALL REPAIRS,PAINT,FLOORING, COUNTERTOPS, APPLIANCE AND FIXTURE REPLACEMENT. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.PERMITAPPLICATION PI.I Il BIN i P�IIMIT APPLICATION <br /> Type of Project: _New — Addn _Alteration _Repair Type of Project: New Addn _Alteration Repair <br /> #of #of List of Fixtures 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 /> Chemical or Water I 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 comply with the State C. tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> //iPERMIT#Owner thori =d Agent Signature (Revised 9/23/2016) <br />