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PERMIT APPLICATION• <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 41047—a 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4919 Evergreen Way PROPERTY TAX#: 0260935 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: QFC#50852 TENANT NAME(If Commercial): QFC <br /> OWNER MAILING ADDRESS: STREET 1014 Vine St <br /> cny Cincinnati STATE OH ZIP 45202 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Advanced Sign & Lighting <br /> CONTRACTOR ADDRESS: STREET PO Box 1483 <br /> CITY Sumner STATE WA ZIP 98390 <br /> CONTRACTOR PHONE: 253-987-5909 CONTRACTOR EMAIL: asl.fenton@gmail.com <br /> CONTRACTOR LICENSE#(REQUIRED): ADVANSL923DP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ®OTHER(Please Specify) Erin Michaels-Agent <br /> CONTACT NAME: CONTACT PHONE: 574-232-5114 <br /> Erin Michaels CONTACT EMAIL: evm@sesbranding.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: No change Contract Price of Work:$ 7.000 <br /> Proposed Use of Building: No change Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Remove existing wall signs, install (1)"QFC Food&Pharmacy"channel letter set, reface existing tenant panel <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> 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/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.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 /> 9/"&zz:-/1 /0 fig//� PERMIT <br /> #I p_l © - <br /> Owner/Authorized Agent Signature Date (Revised 9232016) <br />