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Elm <br /> PERMIT APPLICATIOI <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 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:10110 Evergreen Way PROPERTY TAX#:28042400200400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Emerald City Health Club Prop TENANT BUSINESS NAME(Commercial): Emerald City Athletic <br /> OWNER MAILING ADDRESS: STREET4210 184th Ave SE <br /> cm( Issaquah STATE WA ZIP 98027 <br /> OWNER PHONE: 425-306-7182 OWNER EMAIL: <br /> CONTRACTOR NAME:Sign Associates, Inc. <br /> CONTRACTOR ADDRESS: sTREET6825 176th Ave NE <br /> cin Redmond STATE WA ZIP 98052 <br /> CONTRACTOR PHONE:425-885-6100 ext 13 CONTRACTOR EMAIL:timheyes@signassociatesinc.com <br /> CONTRACTOR LICENSE#(REouIREDD:_Signai*060P6 ti—e C_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 030054 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: c lr . a �c( CONTACT PHONE: 425-417-0072 <br /> 149- <br /> Tim Heyes �d� CONTACT EMAIL: timheyes©signassociatesinc.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:Health Club Contract Price of Work: $6,558.00 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse L 1Duplex LJADU ❑Multi Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: LiNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Install internally illuminated "ECA" logo sign over main entry doors <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 System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:t 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. 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 6I PER , #\� 2' <br /> Owner/Ruth d Agent Signature Date (Revised 10/10/2018) <br /> /2_ <br />