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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' ' ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govlpermits <br /> ( ole or Black Ink Only Please)-: <br /> ' PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2601 Summit Ave, U n: - ' 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) <br /> CONTACT INFORMATION' <br /> OWNER NAME: Evergreen Recovery Centers TENANT NAME(If Commercial): N/A <br /> OWNER MAILING ADDRESS: sTREEr 2601 Summit Ave <br /> crrr Everett STATE WA ZIP 98201 <br /> OWNER PHONE: 4254935310 OWNER EMAIL: mgese@evergreenrc.or <br /> CONTRACTOR NAME: Roofing by Pr, LLC <br /> CONTRACTOR ADDRESS: STREET 13407 Meadow Drive <br /> CITY Snohomish STATE WA ZIP 98290 <br /> CONTRACTOR PHONE: 425-335-0209 CONTRACTOR EMAIL: PRConstruction@frontier.com -1C9111-2)-- ._. <br /> CONTRACTOR LICENSE#(REQUIRED): 603622442 CITY OF EVERETT BUSINESS LICENSE#(REQUIREED): f`.ju f\ , <br /> PRIMARY CONTACT: pt OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: goOF liji- V q(� NI CONTACT PHONE:425-280-7919 <br /> Bruce Soule , CONTACT EMAIL: bsoule C/,evergreenrc.org <br /> a LI<UILDING:PERMIT:APPUCATION '= - . <br /> Existing Use of Building: 40) CT `4?) Contract Price of Work . i Ia e0 C <br /> Proposed Use of Building:Same Heat Source: ❑Gas eiElectric ❑Other <br /> Building Type: CI SFR-Detached ❑SFR-Attached ❑Duplex iulti-Family-#of Units: licc:ommerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Remove existing roofing and install new. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.PERMIT APPLICATION: PLUMBING PERMIT'APPLICATION <br /> Type of Project: _New �• Addn _Alteration Repair Type of Project: New Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures <br /> List of Fixtures Fixtures List of Fixtures Flores List of 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 /> SPRINIO.L R I SUPPRESSION,SYstitik <br /> Chemical or Water J INo.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.lam the owner,or lam authorized by the owner of this properly 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 /> , ,,� n 4// <br /> FF City of E:tett <br /> lOfilCiai Use Only <br /> Owner/Authorized Agent Si ture Date (Revised 9/73/2016) <br />