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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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> Blueor Black InkOnlyPlease) ,,. F Tr <br /> ( PROJECT S{TE tNFORMAT[ON <br /> PROJECT SITE ADDRESS: 14 E Casino Road , Building C PROPERTY TAX#: 28041300105301 <br /> LEGAL for new construction: Short Plat/subdivision Section 13 Township 28 Range 04 Lot No. 1 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Little Red School House TENANT NAME(If Commercial): �' ,1L( i (itve' ttf <br /> OWNER MAILING ADDRESS: STREET 14 E Casino Road, Bldg A <br /> CITY Everett STATE WA ZIP 98208 <br /> OWNER PHONE: 425 353 5656 Ext 7142 OWNER EMAIL: leann.denini@childstrive.org <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: V OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425 353 5656 Ext 7142 <br /> Leann Denini CONTACT EMAIL: leann.denini@childstrive.org <br /> BUILDING,PERMIAPPLICATION, <br /> Existing Use of Building: E Contract Price of Work:$ <br /> Proposed Use of Building: E Heat Source: ❑Gas OElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: VCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Certificate of Occupancy <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 I SUPPRESSION SYSTEM <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 wi State Contractors Law 18.2 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 11011f4e. _ -,, • / - / PSITk#g( 0 °I Li <br /> Owner/ uthorized Agent Signature Date (Revised 9/23/2016) <br /> z <br />