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41*-17 PERMIT APPLICATIO <br /> BUILDIN•MECHANICAL / PLUMBING / SIG PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov l www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:11014 19th Ave SE, Suite 19A PROPERTY TAX#:28051900400400/2896083 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SKOTDAL BROTHERS LLC TENANT BUSINESS NAME(Commercial): Bims Laundry Cafe <br /> OWNER MAILING ADDRESS: STREET2707 COLBY AVE#1200 <br /> c,T' Everett STATE WA ZIP 98201 <br /> OWNER PHONE: David Graef 425 252 5400 OWNER EMAIL:Dave.Graef@skotdal.com <br /> CONTRACTOR NAME:Fastsigns- Everett <br /> CONTRACTOR ADDRESS: STREET2802 Colby Ave <br /> cmTm Everett STATE WA zip 98201 <br /> CONTRACTOR PHONE:425.438.9350 CONTRACTOR EMAIL:Duane.Steig@Fastsigns.com <br /> CONTRACTOR LICENSE#(REQUIRED):CCFASTS**832JK CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 056308 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:Ofc: 425.438.9350 Cell: 360.572.7225 <br /> Duane Steig CONTACT EMAIL:Duane.Steig@Fastsigns.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:599 Other Retail Trade NEC Contract Price of Work: $5,642 <br /> Proposed Use of Building: 599 Other Retail Trade NEC Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Installing and Connecting 1 Illuminated Channel Letter Sign mounted on a raceway <br /> to existing 20 amp dedicated circuit. <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 Ventilation 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: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. 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 /> • <br /> Z7 #—61/1;•• 1/� P IT OO C <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />