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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <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 /> ( i><1e or Blacknk_Only alei�se)., PRO.ICT,$ITE INFORI�fA'tl)ON <br /> PROJECT SITE ADDRESS: 2601 Summit Ave l Un,A 'PROPERTY TAX#: 00-5168-594-011-00 <br /> LEGAL for new construction: Short PlaUsubdivision N/A Lot No. (attach copy of long legal description) <br /> COMACT INF�RIUATIGN'; <br /> OWNER NAME: Evergreen Recovery Centers TENANT NAME(If Commercial): N/A <br /> OWNER MAILING ADDRESS: STREET 2601 Summit Ave <br /> cnY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: 4254935310 OWNER EMAIL: mgese@evergreenrc.org <br /> CONTRACTOR NAME: Roofing by Pr, LLC <br /> CONTRACTOR ADDRESS: STREET 13407 Meadow Drive <br /> CITY Snohomish STATE WA 98290 <br /> CONTRACTOR PHONE: 425-335-0209 CONTRACTOR EMAIL: PRConstruction@frontier.Com '�'�° <br /> CONTRACTOR LICENSE#(REQUIRED): 603622442 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Ma <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ,g5:64 2 ( A .CONTACT PHONE:425-280-7919 <br /> Bruce Soule rV v� CONTACT EMAIL: bsoule©evergreenrc.org <br /> BUILDING'PERMIT APPLICATION <br /> Existing <br /> 17;77 .2.,/ilding: x ( -97 Contract Price of Work:$ 6 <br /> Proposed Use of Building:Same Heat Source: OGas BElectric „POther <br /> Building Type: Li SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Remove existing roofing and install new. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,' MECHANICAL PERMIT APPLICATION-- `PERMIT APPLICATION, <br /> Type of Project: _New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #ofList of Fixtures #of List of Fixtures #of 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 i—Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> Chemical or Water J No.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 296.200A WAC. <br /> City of Everett Official Use Only <br /> �,,,z/ 1?/ <br /> i PERMI/k T g <br /> oe -ozi <br /> Owner/Authorized Agent Si,y ture Date (Revised 9/23/2016) <br /> /1 <br />