12728 19TH AVE SE WESTERN WA MEDICAL GROUP 2017-06-07

PERMIT APPLICATION Li l 0 �� BUILDING :CHANICAL / PLUMBING / SIGN I =RINKLER/-DEMOLITION CITY OF EVERETT PERMIT SERVICE_ OL 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ince Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: ,CV I PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 'd"t\ I {��(GQ� 4, NANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET t) �11< . i CnY STATE �(� ZIP q t1^31 e - OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Berry Sign Systems CONTRACTOR ADDRESS: STREET 7400 Hardeson Rd crry Everett STATE WA zip 98203 CONTRACTOR PHONE: 4257768835X114 ICONTRACTOR EMAIL:tracies@berrysignsystems.coni CONTRACTOR LICENSE#(REQUIRED): berrySs827b7 ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED):24786 PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 47S7 Sfs-3 Y- //V ( CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ Proposed Use of Building: Heat Source: []Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: RINew ❑Addition ❑Remodel ❑Repair ❑T.I. []Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove lKitchen Sink&Disposal Grease Trap Gas Range Ducting IDishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Number of Heads 11 1 ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with 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 Building Official before being authorized under any circumstance./am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and]comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only / PERMIT# Owner/ uthorized Agent Signature Date (Revised 9/23/2016)