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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:4522 Evergreen Way PROPERTY TAX#: 00605502201001 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Damian Properties LLC TENANT BUSINESS NAME(Commercial): State Farm <br /> OWNER MAILING ADDRESS: STREET 4202 114th St SE <br /> CITY Everett STATE WA zIP 98208 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:Heath Northwest <br /> CONTRACTOR ADDRESS: STREET 727 South 96th St <br /> CITY Seattle STATE WA ZIP 98108 <br /> CONTRACTOR PHONE:206-623-3100 CONTRACTOR EMAIL:CrystalC@heathnOthWest.COm <br /> CONTRACTOR LICENSE#(REQUIRED):H EATH N 1981 J E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 04-1617 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-623-3100 <br /> Crystal Canter CONTACT EMAIL:crystalc@heath • est.com <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: 'I1100 <br /> Proposed Use of Building: ('/)yn YMKCA."`-'\ Heat Source: ❑Gas ■Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Famil -#Units: ► .mmercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition DRemodel DRepair ❑T.I. &Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: Installation of(1)LED illuminated channel letter set on raceway under canopy reading"State Farm"w/ <br /> logo. <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 /> A/C—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 Ventilatior 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 SystemNo.of Heads <br /> Chemical Suppression System I 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.lam 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 •- - -Contractors - : 7 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> a RMIT <br /> I3 \ l Lt$9,0SSrG <br /> ^/ <br /> •uthorized Agent Signature Date (Revised 10/10/2018) <br /> J2' <br />