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MINI <br /> • PERMIT APPLICATION <br /> min BUILDING/MECHANICAL/PLUMBING t SIGN /SPRINKLER I DEMOLITION <br /> EVERETT' <br /> V E D E T TCITY OF EVERETT PERMIT SERVICES <br /> L.y`c 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 j FAX 425-257-8857 j(E)everetteps@everettwa.gov j www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please). PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 12902 Bethel- ere Wy, Suite E ,PROPERTY TAX#: <br /> LEGAL for new construction. Short Alatfsut4 )a ire• ✓y b Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION.:; <br /> OWNER NAME: Jade Gan TENANT BUSINESS NAME(Commercial): Genuine Smiles <br /> OWNER MAILING ADDRESS: STREET 12902 Bothel Everett Hwy, Suite E. <br /> crry Everett STATE WA <br /> ZIP 98208 <br /> OWNER PHONE: (425)367-0303 ,OWNER EMAIL:jadegandds@gmait.com <br /> CONTRACTOR NAME: Shawn Spencer <br /> CONTRACTOR ADDRESS: STREET 23425 53rd AVE. SE <br /> ctry Bothell STATE WA ZIP 98021 <br /> CONTRACTOR PHONE:425-449-0277 CONTRACTOR EMAIL: Spencfab.G aol..COr <br /> CONTRACTOR LICENSE#(REQUIRED):#SPENCSM903L9 CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER !]CONTRACTOR 0 OTHER(Please'Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-468-3999 <br /> Tony Le CONTACT EMAIL: ussignllc@gmail.com <br /> BUILDING INFORMATION <br /> Existing Use of Building: Medical Contract Price of Work:$4500 <br /> T <br /> Proposed Use of Building: HegtAqurce: OGas ❑Electric ❑Other <br /> BUILDING USE: OSFR ['Townhouse ['Duplex QADU IJMulti-Family-#Units: ✓['Commercial ['Accessory Structure <br /> Type of Project: ['New ❑Addition DRemodel ❑Repair CIT.1. I]Sign ['Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: Install of one(1)set of channel letters on raceway. Sign will be Led illumination and attached to existing, <br /> wall sign. Sign will be hooked up to existing sign circuit. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture Fixture Fixture <br /> Count count List of Fixtures Count List of Fixtures List of Fixtures <br /> Count <br /> NC—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 Ventilatio 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/SUP PRESSION.SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System INo.of Heads <br /> Chemical Suppression System I INo.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 ly with the State Contractors L 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 2 /L�J <br /> PERMIT#v`^ _ ( U� 004 <br /> 09/09/2020 t y <br /> Owner thorized Agent ignature Date (Revised 10/10/2018) <br /> 170.7 <br />