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PERMIT APPLICATION <br /> #111701. -"4 <br /> BUILDIN —MECHANICAL / PLUMBING /SIGN•• =RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 IFAX 425-257-8857 I(E)everetteps@everettwa.gov lwww.everettwa. ov/permits <br /> t- o f . ',"�1y P . „Y L r.. ' ',z.,.-:,IP OJE At HFO w n i �� , �j <br /> �� a <br /> PROJECT SITE ADDRESS: Station #3020 11 I)Z5 Airport Road PROPERTY TAX#: ROW(Adjacent to#011254-Open Space) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 40,042;;',':: x.. . 1,-,s! ri .. .1 ..f oNi NFQIRM v i9 ��. om /lt o . i t <br /> OWNER NAME: Community Transit TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7100 Hardeson Road <br /> c,Ty Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425-348-2367 OWNER EMAIL: todd.jacobs@commtrans.org <br /> CONTRACTOR NAME: To Be Determined til ra4/vl S-� <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: 0 OWNER 0 CONTRACTOR 8 OTHER(Please Specify) Engineer <br /> CONTACT NAME: CONTACT PHONE: 425-739-4242 <br /> Wlndl Shapley CONTACT EMAIL:windi.shapley@otak.com <br /> min;." , tZZ. ,. r.....x t...laa .UIm. G,PE.. ,.. "`Aj � ..1;.; te„ .. .rte e iia *. '/; <br /> �r <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: la Commercial ❑Industrial <br /> Type of Project: lr7New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑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 and signal improvements. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> INumber 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 •• i i_ • - <br /> City of Everett Official Use Only <br /> 3. -- ....%"--""-'-----7" <br /> PERMIT# <br /> Owner/Auth•'ed Agent Signaturei/Sf14 01 <br /> S i.I-APc mate (Revised 9/23/2016) <br /> G-----D- <br />