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<br /> PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION
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<br /> , CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.govlpermlts
<br /> 181414 $lack i+l>1 0410 440 .<.. : ,, ,PROTECT$IT INFORMA'I Of .. ... .,,,: . 3 ...,. ,_. .. ..:.,
<br /> PROJECT SITE ADDRESS:2601 Summit Ave , UA x°+- Ar PROPERTY TAX#: 00-5168-594-011-00
<br /> LEGAL for new construction: Short Plat/subdivision N/A Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: Evergreen Recovery Centers TENANT NAME(If Commercial): N/A ,
<br /> OWNER MAILING ADDRESS: smEEr 2601 Summit Ave -
<br /> CITY Everett STATE WA ZIP 98201
<br /> OWNER PHONE: 4254935310 OWNER EMAIL:mgese aeeverrreenrc.or9
<br /> CONTRACTOR NAME: Roofing by Pr, LLC
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<br /> CONTRACTOR ADDRESS: STREET' 13407 Meadow Drive
<br /> ow Snohomish STATE WA ZIP 98290
<br /> CONTRACTOR PHONE: 425-335-0209 CONTRACTOR EMAIL: PRConstruction@frontier.com --
<br /> CONTRACTOR LICENSE#(REQUIRED) 603622442 CITY OF EVERETT BUSINESS LICENSE#(REQUI D) 1\)01\k,
<br /> PRIMARY CONTACT: (2 OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:425-280-7919
<br /> �-®����.`�� N tom,.
<br /> Bruce Soule , CONTACT EMAIL: bsoule anevtsenrc.org
<br /> ., BUILDU IG PERMIT AP LICAT :;. l
<br /> Existing Use of Building: - -a) Contract Price of Work: ! 1 OW
<br /> Proposed Use of Building:Same Heat Source: OGas BElectric i ❑Other
<br /> Building Type: DSFR-Detached C]SFR-Attached ❑Duplex tuiti-Family-#of Units: ommercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI ❑Sign ❑Sprinkler IJ�emc�olition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> Remove existing roofing and install new.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> n.,..,l �IMECM0410 PFRM�Y'*** , �/ "i.:.:ig:f, .,I J...r.a.� . .r,.. K0019)11��1 WEIWIV OPV0 1 /.�{x:31, ,},nr.f....-t.
<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 #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC-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 /> I
<br /> Chemical or Water I INo.of Heads
<br /> ACKNOWLEDGEMENT l 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,slate,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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> ,� j City ofEverett Official Use Only
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<br /> Owner/Authorized Agent Si ture Date (Revised 9/23/2016)
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