12806 19TH AVE SE BROOKDALE SENIOR LIVING 2021-12-13

04-77 PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please V PRRECT SITE INFORMATION PROJECT SITE ADDRESS:12806 B. I.' - -it- , Everett, WA 98208 PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision N/A Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Brookdale Arbor Place TENANT BUSINESS NAME(Commercial): Brookdale Senior Living OWNER MAILING ADDRESS: STREET6737 W Washington St STE 2300 CITY Milwaukee STATE WI ZIP 53214 OWNER PHONE: 888-221-7317 OWNER EMAIL:N/A CONTRACTOR NAME:JRC, Incorporated CONTRACTOR ADDRESS: STREET2098 Tom Austin Hwy CITY Greenbrier STATE TN ZIP 37073 CONTRACTOR PHONE:615-851-1725 CONTRACTOR EMAIL:jkassner@jrcinco.com 14.01, 1 ,, Qy CONTRACTOR LICENSE#(REQUIRED):603-370-537 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Applied/Paid for iton4/2/191J�' `� PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:615-851-1725 Jerry Kassner CONTACT EMAIL:jkassner@jrcinco.com BUILDING INFORMATION Existing Use of Building:Senior Living Facility Contract Price of Work:$154,889.16 Proposed Use of Building:Senior Living Facility Heat Source: ❑Gas DElectric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ✓❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ✓❑Remodel ❑✓Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Shingle Re-roof. NOTHING STRUCTURAL. Remove existing shingles down to deck and install back shingle system. Not adding any more weight to the building. — Set -1-4.k--4011/0110-1° roo}' n ASSOCIATED BUILDING PERMIT#(if applicable): N/A MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures N/A A/C-Air Handling Units N/A Gas Piping N/A Backflow Preventer(Inside Bldg) N/A Shower,Tub,or Combo - Boiler i Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) / Clothes Dryer Heat Pump&Ductless \ Dishwasher Sink-Residential(kitchen,bath,bar) ) Duct System(Remodel) Refrigeration J Drinking Fountain Sink-Utility,laundry,mop ( Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet \ Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Medical Gas Water Service(behind meter) Forced Air Systems Other: Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER I SUPPRESSION SYSTEM N/A Sewage Ejector or Sump Pump N/ Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# -`I b4 Oil 04/02/2019 t_•Yp Owner/ h rized Agent Signature Date (Revised 10/10/2018) Z