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PERMIT APPLICATION <br /> 0001/,411111 <br /> BUILDIN_CHANICAL/PLUMBING /SIGN 1 mRINKLER/DEMOLITION <br /> 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. ovwww.everettwa. ov/ ermits <br /> I IO p@ s I s p <br /> Iglu or I sk * � PRa f N RlVilf� 1 3N <br /> ,.ruxn,�-�.r��,F �-_ i �S.aan.., h�h�, _ ,..!� a; � _ _ 6i= �v� �nmw��•%•�f,,15.�a��e( ;7;,-; <br /> PROJECT SITE ADDRESS: Station #3039 112.10 Airport Road PROPERTY TAX#: ROW(Adjacent to#00537900006600) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) • <br /> OWNER NAME: Community Transit TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7100 Hardeson Road <br /> ciTy Everett STATE WA zip 98203 <br /> OWNER PHONE: 425-348-2367 OWNER EMAIL: todd.jacobs@commtrans.org <br /> CONTRACTOR NAME: To Be Determined <br /> CONTRACTOR ADDRESS: STREET <br /> Ur( STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4_ qc-L3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ZI OTHER(Please Specify) Engineer <br /> CONTACT NAME: CONTACT PHONE: 425-739-4242 <br /> Winds Shapley CONTACT EMAIL:windi.shapley@otak.com <br /> l��::,� rc-s .��� <br /> � :: �, !.fit� f ,a-ea. y 5,•�k ,,,,r, - Tf ... ,. .a /� i�'�l�✓.. ,,,.,.... � ..t.�, ,.. <br /> Existing Use of Building: Contract Price of Work:$200,00 <br /> Proposed Use of Building: Bus Shelter Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: TC]Commercial 0 Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.l. ❑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 /> : B1NG P RMI1 I PUCATtON ,, A A S <br /> Type of Project: New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f 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:1 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 1 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 /> J /,City/of Everett Official Use Only <br /> rA <br /> � R S 2-01(40 PERMIT 1% ((ia(A OU <br /> Own>P!'':'ey? ignature t%7bt A, 5 " Dat- (Revised 9/23/2016) <br />