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PERMIT APPLICAAN <br /> /g°04Z*(--/--A 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 (E)everetteps@everettwa.gov l www.everettwa.gov/permits <br /> (Blue or Black Ink Orily'Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 221 SE Everett Mall Way#m-3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • .: CONTACT INFORMATION <br /> OWNER NAME: Zoom Care TENANT NAME(If Commercial): ZOOM CAre <br /> OWNER MAILING ADDRESS: STREET Site address <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: TubeArt <br /> CONTRACTOR ADDRESS: STREET 11715 SE 5th ST <br /> crrY Bellevue STATE WA ZIP 98005 <br /> CONTRACTOR PHONE: 206 679 8732 CONTRACTOR EMAIL: shawnb@tubeart.com <br /> CONTRACTOR LICENSE#(REQUIRED): TUBEAD*311 QS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): h <br /> PRIMARY CONTACT: 0 OWNER ,V CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206 679 8732 <br /> Shawn Bowen CONTACT EMAIL: shawnb@tubeart.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:clinic Contract Price of Work:$ 4500.00 <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. VSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Install 1 wall sign AA <br /> ASSOCIATED BUILDING PERMIT#(if applicable): '�v(:)1' Obi <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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'/SUPPRESSION SYSTEM <br /> Chemical or Water 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.lam the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Shawn Bowen 5/2 on.), ®� <br /> Owner/.Authorized Agent Si Date (Revised 9/23/2016) <br /> /2 <br />