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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING!SIGN /SPRINKLER/DEMOLITION <br /> C�TY 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 /> {Btue ar Black Ink Only Piease) PROJECT SITE iNFORMATtON <br /> PROJECT SITE ADDRESS: 4830 Evergreen Way, Everett,WA 98203 PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsubdivisiorr Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Emerald City Pizza TENANT NAME(If Commercial): PIZZB HUt <br /> OWNER MAILING ADDRESS: srReer 12121 Harbour Reach Dr#200 <br /> o,,,� Mukilteo STATE WA z�P 98275 <br /> OWNER PHONE: 425.493.8077 OWNER EMAIL: rhernandez@emeraldcitypizza.com <br /> CONTRACTOR NAME: O'Sage Signs LLC <br /> CONTRACTOR ADDRESS: s�raaeer 15107 50th Ave E <br /> arr Tacoma STATE WA ziP 9844 <br /> CONTRACTOR PHONE: 206.396.1036 CONTRACTOR EMAIL: osagesigns@hotmail.com <br /> CONTRACTOR LICENSE#(REQUIRED): OSAGESL8805A CITY OF EVERET7 BUSINESS LICENSE#(REQUIRE • � <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206.396.1�36 <br /> Ken O'Sage coNTacT eMai�: osagesigns@hotmail.com <br /> ' BUILDING PERMlT AI�PLI�ATION <br /> Existin Use of Buildin : Restaraunt Contract Price of Wor $ 200 <br /> Proposed Use of Building: Restaraunt Heat Source: ❑Gas ❑Elect ic ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: Commercial ❑Industrial <br /> Type of Pro"ect: ❑New ❑Addition ❑Remodel ❑Repair �T.1. Sign ❑Sprinkler olition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Remove 2 wali signs, Install 2 wall signs, Reface 1 monument <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIGATION <br /> Type of Projeck: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of tist of Fi�ures #of Lisf of Fixtures #of List of Fi�cfures <br /> Fixtures Fixtures Flxtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavatory(Wash Basin} Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Range Du�ting Dishwasher Roof Drains <br /> Clothes Qryer Hookups Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BarlMop/etc.) Other: <br /> SPRINKLER`/SUPPRESSION SYSTBM" <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have roviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,sfate,and Iocal law.The granting of a permit only authorizes approved woric and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial 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, <br /> and I comply with the State Contracto�s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> ,r�r"'� 7Gcs� PE T#��� ` oO � <br /> � � s� /� /� / <br /> wnerlAuthorized Agent Signature Da e (Revised 9/23/2016) �" ^ <br /> �v <br />