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PERMIT APPLICATIOI <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PRo�eCT SITE AD�RESS: 909 SE EVERETT MALL WAY 420 EVERETT WA pROPERTY Tax#: 28051800300400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: BAKERY OUTLET TENANT NAME(If Commercial): BAKERY OUTLET <br /> OWNER MAILING ADDRESS: srReeT 909 SE EVERETT MALL STE 420 <br /> cirv EVERETT sTnre WA zia 98208 <br /> OWNER PHONE: OWNER EMAIL: <br /> coNrRACTOR NAME: NATIONAL SIGN CORP � <br /> CONTRACTOR ADDRESS: srReEr 1255 WESTLAKE AVE N <br /> cirr SEATTLE sraTe WA ziP 98109 <br /> CONTR,4CTOR PHONE: (206) 282-0700 CONTRACTOR EMAIL: STEVEZ@NATIONALSIGNCORP.COM <br /> CONTRACTOR LICENSE#(REQuiREo): NATIOSC031 M3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0003006 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (206) 282-0700 <br /> STEVE ZAMBERLIN CONTACT ennAi�: STEVEZ@NATIONALSIGNCORP.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1,200.00 <br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: C�Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. 6�Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> INSTALL ONE SINGLE FACE ILLUMINATED WALL SIGN, REAR BUILDING ELEVATION <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 #�f List of Fixtures #of ��st of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <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 /> Ran e 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 re iewed this application and confirm the information contarned herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and ocal l�The granting of a permit only authorizes approved work and no deviafions therefrom Deviations must first be authorized in writing from the <br /> Building Official before b ing au�h�rrized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the S te C��tr,�ctors Law 18.27 RCW and 296.200A WAC. <br /> j' City of Everett Official Use Only <br /> �' '� PERMIT# <br /> � ;�� 3 Z 7�1 � l � t,- .`�-- � C�__ <br /> Owner/Authorize Ag Si �ture Date (Revised 9/23/2016) <br /> � <br /> � <br /> 1 <br />