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"I:LA <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / <br /> ill / DEMOLITION <br /> '4 diV • <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.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:9900 12th Ave W EVERETT, WA 98204-1133 PROPERTY TAX#:28041400400600 9900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: BREIT TA MF WALDEN POND LLC TENANT BUSINESS NAME(Commercial): The Winsley(current Weldon Pond Apartments <br /> OWNER MAILING ADDRESS: STREET 233 S WACKER DR SUITE 4200 <br /> ciry CHICAGO STATE IL zip 60606 <br /> OWNER PHONE: 206-446-8803 OWNER EMAIL:spacquer@truamerica.com <br /> CONTRACTOR NAME:Orca Sign Company <br /> CONTRACTOR ADDRESS: STREET 548 So. 146th St. <br /> CITY Seattle STA FE WA ZIP 98168 <br /> CONTRACTOR PHONE:206-433-8230 CONTRACTOR EMAIL:orCasign@yahoO.com <br /> CONTRACTOR LICENSE#(REQUIRED):ORCASSC842D8 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER D CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-433-8230 <br /> Bruce Mildenberger CONTACT EMAIL:orCasign@yahoo.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:apartments Contract Price of Work:$5000.00 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex I_7ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New Addition ❑Remodel ❑Repair ❑T.l. ✓❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Remove existing signs (2) and replace with new <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub, or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility, laundry, mop <br /> Exhaust Fans(Residential) Commercial Ventilator Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other <br /> Water Suppression System No. of Heads <br /> Chemical Suppression System 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 Officra7-FeTre 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 wit he State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br />/ e en/ t orifi Agent Si nature Date (Revised 10/10/2018) <br /> 0 ,l <br /> t1 <br />