11419 19TH AVE SE IMPACT HEALTH 2020-02-24

Eci....._il.,,,.... PERMIT APPLICATIM IS BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLE DE.4 LI i D CITY OF EVERETT PERMIT SERVICES 019 1 u z EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa 6A'e- qv, villa- N (Blue or Black Ink Only Please@@q�(� J1 "" '1-A-17--SITE INFORMATION l \ PROJECT SITE ADDRESS:t\ L �k-k 1 �� ,.9s6-2, j PROPERTY TAX#:01105500000200 LEGAL for new construction: Short Plat/subdivision ,N,_ k_cy ll Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Luba Evmeshkina TENANT BUSINESS NAME(CommercialV1/462,g(A.... ): OWNER MAILING ADDRESS: STREET 11419 19th Ave Se Suite A108 c!Ty Everett STATE WA ZIP 98028 OWNER PHONE: 425-465-4415 OWNER EMAIL: Dr.Luba.ND@gmail.com CONTRACTOR NAME:Sign Pros Inc CONTRACTOR ADDRESS: STREET PO Box 2518 CITY Redmond STATE WA ZIP 98073 CONTRACTOR PHONE:425-885-3204 CONTRACTOR EMAIL:Mike@signpros.net CONTRACTOR LICENSE#(REQUIRED):SIGNPI*017N7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 59989 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-836-6069 Dustin Lippert CONTACT EMAIL:dustin.lippert@signpros.net BUILDING INFORMATION Existing Use of Building:Commercial Contract Price of Work:$795.00 Proposed Use of Building:Commercial Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex EADU ElMulti-Family-#Units: _ ❑Commercial EAccessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑✓Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 77.5"x 42"Aluminum Composite sign to be mounted to brick facade above business door. ASSOCIATED BUILDING PERMIT#(if applicable): 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 A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler 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 Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior 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 Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump 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 PER Dustin Lippert Digitally signed peLippert 11/12/2019 `gI t \ te \ C) _ Owner/Authorized Agent Signature Date (Revised 10/10/2018) �/``