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-‘141*-77- PERMIT APPLICATION <br /> BUILDING , MECHANICAL / PLUMBING / SIGN / ..: RINKLER / 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 505 SE EVERETT MALL WAY, UNIT 3/4 PROPERTY TAX#: 28051800304800 <br /> LEGAL for new construction: Short Plat/subdivision Lot No.3 (attach copy of long legal description) <br /> CONTACT INFORMATION k . Vref Tr <br /> OWNER NAME: GREENTREE PLAZA 06A LLC TENANT NAME(If Commercial): IL LLC <br /> OWNER MAILING ADDRESS: STREET 505 SE EVERETT MALL WAY <br /> CITY EVERETT STATE WA ZIP 98208 <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: ` i, fl/tIAt.1" 3/11,144" D GYI } <br /> CONTRACTOR ADDRESS: STREET , b -1b2 / O2_.ti, <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: ( CONTRACTOR EMAIL: ('//,60-2-?)--)-- l2 6d,I <br /> CONTRACTOR LICENSE#(REQUIRED): (�)���1} L{ K CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) ARCHITECT K 711 1412 <br /> CONTACT NAME: CONTACT PHONE: 4253778786 O 3 <br /> MARTIN REIMERS, CONCEPT ARCHITECTU CONTACT EMAIL: mreimers©conceptarchitecture.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:RETAIL/ BUSINESS Contract Price of Work: $50000 <br /> Proposed Use of Building: KICK BOXING STUDIO Heat Source: ❑Gas ❑Electric ❑Other EXIST. <br /> Building Type: ESFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: UCommercial Dlndustrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair EIT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> COMBINE SUITES 3 AND 4 AND CH LAYOUT <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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/ 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_uthorized 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.nt(actors aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Al.. PERMIT# I <br /> /l /o 3 cG1 --- DIo <br /> Owner/Au h• ized Agent Signature D e (Revised 9/23/2016) <br /> (11Z <br />