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PERMIT APPLICATION <br /> BUILDING/IVf-tANICAL/ PLUMBING/SIGN /SP�LER/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� wuvw.everettwa.gov/permits <br /> �$liit+���Black i»ic�p�teasej , ,' ,�RO:�ECT,51"�'����'O�YI�[Tt�N <br /> PROJECT SITE ADDRESS: 15 SW Everett Mall Way Everett,WA 98204 PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ' , ` ,' ` '' ` .�ONfi�1C'T 11+{��RIYf�t1�1�i ; <br /> OWNER NAME: Vicky McDermott TENAN7 NAME(If Commercial): Vida Integrated Health <br /> OWNER MAILING ADDRESS: STREET PO BOX 5003 <br /> ��n' Bellevue sTA� WA Z1P 98009-5003 <br /> OWNER PHONE: 425.289.2234 OWNER EMAIL: vick m@rosenproperties.com <br /> CONTRACTOR NAME; Advanced Sign and Lighting <br /> CONTRACTOR ADDRESS: STREET 1 37th St.NW <br /> arr Auburn STATE WA vP 98001 <br /> CONTRACTOR PHONE: (253)347-5039 CONTRACTOR EMAIL: asl.taylor j@gmail.com <br /> coNTttACTOR�iceNse#�REQuiRE�>: ADVANSL923DP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D <br /> PRIMARY CONTACT: �OWNER ■CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253Z43.7777 <br /> Lee Bombacie <br /> CONTACT EMAIL: lee.bombacie@shineonsigns.com <br /> ; �.; ; - <br /> = , ;.; • . B�#�:Ii1NG RE��'�FI;ICIl�IOt� . .,,r{... ' <br /> Existing Use of Building: Contract Price of Work:$ $3 000 <br /> Proposed Use of Building: Heat Source: ❑Gas ■Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil �of Units: ■Commercial ❑Industrial <br /> T pe of Pro'ect: ❑New �Addition ❑Remodel �Re air ❑T.1. �Sign ❑Sprinkler ❑Demolition �Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Illuminated Aluminum Channel Letters w/TranslucentVinyl <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> � ����r��►w�car�ri�t�zr mP��:�cn�t�a�. ., , i��.uMBr��e��ar�t n�Ru�at��±��rr <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of ��st of Fixtures #of uy�t of Fixfures #of �y-�of Fixtures #of �yY of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <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) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Ran e Ductin 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 /> �, ��'#�11�MKI.ER/S�1l�FRE:fS4ON S��TEIY� r�:` <br /> Number 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 comp/y 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 Officia/before being authorized under any circumstance.l am the owner,or 1 am authorized by the owner of this prope�ty to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia!Use Onty <br /> � PERMIT� ^ � � <br /> 11.29.2016 U �" <br /> Owner/Auth ri d Ag Signature Date (Revised 9/23/2016) <br /> � <br /> �,� <br /> � <br />