1031 SE EVERETT MALL WAY MODERN DENTISTRY 2019-01-29

4rErr PERMIT APPLICATIO4— BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) "`. PROJECT SITE iNFORMATION PROJECT SITE ADDRESS: /0 3 j SE 6vE,A.Eir N-V1LL (A/Ay PROPERTY TAX#:2$pi kOO 30g300 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:L/g(2E'7r COV&NAAnT GfOvF LZ L' TENANT NAME(If Commercial):E/ 0406E4Rak) bek")at 2y OWNER MAILING ADDRESS: STREET 1700r � (-1/L� Av c CITY IRVI JC STATE CA ZIP 92.G'Jy OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: LE'Q„7 O' S/&#J SE2✓)c CONTRACTOR ADDRESS: STREET S2CII /2,241%. .5T € CITY-r-Aco►. STATE I A ZIP g g'i7,410,C CONTRACTOR PHONE 53-S3l o7$Z CONTRACTOR EMAIL: CS5P'el2wt lTT (D 6WlA/L COWI- CONTRACTORLICENSE#(REQUIRED):C"- Ss g9 2N6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OS 369 S PRIMARY CONTACT: ❑OWNER 2 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2S 3 f 32 -07S 4003 V`5SZte CONTACT EMAIL:CSsPE,2W,Frs.e ,COw- BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work:$ Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: )BCommercial ❑Industrial Type of Project: ❑New ❑Addition 0 Remodel ❑Repair DTI. Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 1N.s 'ALL. ONE )eUrgi(A/Aky —IG.LI;/W►)NA-- J ii1ALZ, 5l6,0 OA) 7-4)( --1- AMA.TrS )e.) (5007, ) &^rEte/a ELEI/47)0/`I ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC-Air Handling Units _Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water No.of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. ,�� City of Everett Official Use Only h'�u�tj 175//4/2 O17 PERMIT# 611() 5-010 Owner/Authorized Agent Signature (Revised 9/23/2016)