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PERMIT APPLICATION <br /> BUILDING—IECHANICAL / PLUMBING /SIGN • RINKLER/ DEMOLITION <br /> l�' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E)everette s everettwa. ov www.everettwa. ov/ ermits <br /> I Ip@ s i s p <br /> PROJECT SITE ADDRESS: Station #3037 8s j e airport Road PROPERTY TAX#: ROW(Adjacent to#28041500100100) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> z . <br /> oar eA . .. ,,,,;,;771 i <br /> OWNER NAME: Community Transit TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7100 Hardeson Road <br /> cn-y Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425-348-2367. OWNER EMAIL: todd.jacobs@commtrans.org <br /> CONTRACTOR NAME: To Be Determined 6itaAt,44 eril 5 f-, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE - ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4 741-- 3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 8 OTHER(Please Specify) Engineer <br /> CONTACT NAME: CONTACT PHONE: 425-739-4242 <br /> Windi Shapley CONTACT EMAIL:windi.shapley@otak.com <br /> Fns ;`'.: ..-., -�.,._ ■iN .._,___ * _.__....: „., -. 1.:=I ,. ,2,7;;:::..,, __- a 'i4 . . <br /> Existing Use of Building: Contract Price of Work:$200,00 <br /> Proposed Use of Building: Bus Shelter Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 17Commercial ❑Industrial <br /> Type of Project: TGINew ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Community Transit Swift II Bus Rapid Transit (BRT) - Construct Swift BRT station shelter and associated roadway improvements. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> /;,,47*. 011.. -e 4 r.1., 1#04,,Y %25,,' <br /> e 25 ,:p,. ""'Y. a, .TM star,,,. fill;., ......�,c _,� ,d . h.fyk .._ <br /> Ar � f <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 /> Number 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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> if City offE(0(0' . ..0(3 <br /> ve�rett Official UserOnly \: ,2 2 (� PERMIT# 1 l�(� + l \ <br /> Owner/Authori ed A ent nature (Date 1 (Revised <br /> 1 9/23/2016) <br />