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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.everetfinra.gov/permits <br /> � ,. , y �.,- ,�a� %��,�-�� <br /> �i���� �, � ,� � %.��' � � <br /> PROJECT SITE ADDRESS: 1305 SE Everett Mall Way PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> � , .� � <br /> �.z._:. � � �k���i;'�'�'� ...:�-. ' '� ,ex��""��S� ��.G �n; <br /> �. ......._ .::,... r,,..., , .,.. � : <br /> , ......... . ..: . . _.. . ..„_:: .� ....�,. .. .... '.:�.... . .__�. .�.,,;.�„ <br /> .. .:.. ,;..._.. . "r:_.. _._ � <br /> OWNER NAME: Red Robin TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer 1305 SE Everett Mall Way <br /> ciTr Everett STATE WA ziP 98208 <br /> OwNER PHONE: 425-355-7330 OWNER EMAIL: <br /> CONTRACTOR NAMe: Simon Roofing and Sheet Metal Corp <br /> CONTRACTOR ADDRESS: srReer 70 Karago Avenue <br /> �iT. YoungstOW11, STATE Ohlo ziP 44512 <br /> CONTRACTOR PHONE: 330-629-7663 EXT: 1123 coN'rtZ4crOR eMai�: cdonitzen@simonroofing.com <br /> CONTRACTOR LICENSE#(REQUIRED): CC SIMONRS94HNT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 330-629-7663 EXT: 1123 <br /> Cindi Donitzen CONTACT EMAIL: cdonitzen@simonroofing.com 4� <br /> �� �,� `�:`���� 'n ����; �1���'�",»�P� _;� �r�;° <br /> Existin Use of Buildin : ReStBUrant Contract Price of Work:$ 42 641.75 <br /> Pro osed Use of Buildin : N/A Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T pe of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: Roof restoration, clean roof, embed a poly fabric in an adhesive, 2-3 coats of a liquid membrane. <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> :� �., .�w.��" �����?���� "�,' � <br /> ., ,.. ,.,,. ,..�_..... ... , ,, <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of �st of Fixtures #�f List of Fixtures #°f List of Fixtures #�f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixiures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Dis osal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other. <br /> ��� ,�', <br /> Chemical or Water No.of Heads <br /> 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 <br /> current federal,state,and/ocal law.The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officia/before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to pertorm the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Ciry of Everett O�cia/Use Only <br /> ��� July 13, 2017 PERMIT � �� �� I <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) � <br /> �� � <br /> . <br />