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PERMIT APPLICATION <br /> � BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black,InkOnl ,°Please. PROJECT SITE INF `,RMA ION, V . <br /> PROJECT SITE ADDRESS:9502 19th ave SE Suite F PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT,INFORMATiO. <br /> OWNER NAME: Hand in Hand TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9502 19th ave SE Suite F <br /> CITY Everett STATE WA ZIP 98208 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Berry Sign Systems <br /> CONTRACTOR ADDRESS: STREET 7400 Hardeson Rd <br /> cITY Everett STATE WA zip 98203 <br /> CONTRACTOR PHONE: 425.776.8835x114 CONTRACTOR EMAIL: tracies@berrysignsystems.com <br /> CONTRACTOR LICENSE#(REQUIRED): berryss857b7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):024786 <br /> PRIMARY CONTACT: 0 OWNER jZI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.776.8835 x114 <br /> Trade Skiles CONTACT EMAIL:tracies@berrysystems.com <br /> .._ .,. ,• , . , [ I DING PEI MITyAPPLICA"fTIOIN , ;:G__ i <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electricer <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. I,Z.ISign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> install 1 non-lit sign <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 'MECHANIICAL PERMIT APPLICATION'`, . , , PLUMBING PERMIT APPLICATION ,,, <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #xtures of List of Fixtures #of List of Fixtures #of <br /> Fixtures Fixtures List of Fixtures #of <br /> Fixtures <br /> FiList of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �SPRINKLER}I SUPPREESSION SYSTEM , <br /> Number 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and I co"•ly with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Own orized ignature D to (Revised 9/23/2016) <br />