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PERMIT APPLICA-1114111 <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,411 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2930 Maple St PROPERTY TAX#: 00439069505800 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTAY�T INFORMATION„` !ri.r, 'int s, <br /> OWNER NAME: Kaiser Permenete TENANT NAME(If Commercial): same <br /> OWNER MAILING ADDRESS: STREET site address <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: TubeArt <br /> CONTRACTOR ADDRESS: STREET 11715 SE 5th St <br /> CITY Bellevue STATE WA ZIP 98005 <br /> CONTRACTOR PHONE: 206 264 2954 CONTRACTOR EMAIL: shawnb@tubeart.COm <br /> CONTRACTOR LICENSE#(REQUIRED): TUBEAD*311 QS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)• 006667 <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) 4 <br /> CONTACT PHONE: 206 264 2954 <br /> CONTACT NAME: Shawn Bowen <br /> CONTACT EMAIL: ShaWnb@tube-+ Om <br /> k� BUIL 11 ERMIT AP I,ICAT101+1„'''I' `s <br /> Existing Use of Building: Contract Price of Work:$' 15000.01 <br /> Proposed Use of Building: Heat Source: ❑Gas •Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ■Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Install 3 wall signs <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT,APPLICATIOII!I1 '',!j, 4:000,04t#01124143100 <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> zi SPRINIKLER/,:(010:ESSION SYSTEI 1 g1li <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 comply 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 Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> '411Wit <br /> PERM 009 <br /> Owner : ize.'4= Signature Date (Revised 10/12/2015) <br /> rZ <br />