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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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Sithe or Black ink Only Please) PROJBCT,SITE INFORMATION , . . <br /> PROJECT SITE ADDRESS: 2601 Summit Ave } u 6,'4.3 E„ 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: sMREEr 2601 Summit Ave <br /> cry 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 /> cm( Snohomish STATE WA ZIP 98290 <br /> CONTRACTOR PHONE: 425-335-0209 CONTRACTOR EMAIL: PRConstruction@frontier.com .075.A--1 - -__. <br /> CONTRACTOR LICENSE#(REQUIRED): 603622442 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I`JON• <br /> PRIMARY CONTACT: p OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ODS �(� / <br /> itI - NII t CONTACT PHONE:425-280-7919 <br /> Bruce Soule °L 6.J � � CONTACT EMAIL: bsoule@evergreenrc.org <br /> . .., BUILDING.PERMIT APPLICATION . - <br /> Existing Use of Building: ' ,,•h jt Ci.:-.?) Contract Price of Work:$ 5 W�y;O(J <br /> Proposed Use of Building:Same Heat Source: ❑Gas BElectric ❑Other <br /> Building Type: (JSFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units:_ iiKintnercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Remove existing roofing and install new. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERM IT:APPUCATION;<. PLUMBING;'PERMIT APPLICATION, . <br /> Type of Project: New Addn Alteration _Repair Type of Project: _TNew 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 /> AIC—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 /> `: SPRINKLER I SUPPRESSION SYSTEM;: ', <br /> Chemical or Water J INo.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,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 properly to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �,% J1 p / City of Everett Official Use Only <br /> //l/l�� ` J r�J PERMI/./kN1?)661 _ z)br2......... <br /> I/2_Owner/Authorized Agent Si ture Date (Revised 9/23/2016) <br />