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PERMIT APPLICATIO4- <br /> 111.11111 <br /> BUILDIN_CHANICAL/ 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 /> PROJECT SITE ADDRESS: Station #3021 I/831 Airport Road PROPERTY TAX#: ROW(Adjacent to#00380900104200) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> WfaalIVfithillNitilitikiMgrit**0001#0*W:..:714*tillitaitAk:AIV;;;;hint AV''' ST <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 616,14),,b, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): (CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 64-11,53 <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 /> - Z ,. 3 „" IE#U1I.I *PEiRI .I*T ?,,6 _ , <br /> Existing Use of Building: Contract Price of Work:$200,00 <br /> Proposed Use of Building: Bus Shelter Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ZCommercial 0 Industrial <br /> Type of Project: TCINew ❑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 /> v ,E A Tx , 1n $ ', rf 1 .! :. e..„ i. _ O PERMIT,AJ'P.I I•GATION• • ` ; ;. :!. <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 /> *KL**:.' 7: . N SYSTE' ,,... <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 beforebeing 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 /> City of Everett Official Use Only <br /> r PERMIT <br /> Fis-la.16 1(01 -,01D <br /> Owner/Author' gent Signature IN pt A. S c-NkrDate (Revised 9/23/2016) Et / <br />