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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> /°141‘1 ---00!:a CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Onlyse) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 30 ukilteo Blvd,Everett WA 98203 'PROPERTY TAX#:00606200004101 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Hwan Young, LLC TENANT NAME(If Commercial): 76 Site #881893 <br /> OWNER MAILING ADDRESS: STREET 5327-25th Ave West <br /> cm' Everett STATE WA LP 98203 <br /> OWNER PHONE: (425) 231-0129 OWNER EMAIL: jinheekw@hotmail.com <br /> CONTRACTOR NAME: Insignia Sign Inc. <br /> CONTRACTOR ADDRESS: STREET PO BOX 2849 <br /> cnY Renton STATE WA zip 98056 <br /> CONTRACTOR PHONE: (425) 917-2109 (CONTRACTOR EMAIL: cthomson@insigniasign.com i <br /> CONTRACTOR LICENSE#(REQUIRED): INSIGSIO62QZ CITY OF EVERETT BUSINESS LICENSE#(REQUI ): 038029 <br /> PRIMARY CONTACT: 0 OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (425)917-2109 ' -------- <br /> Cindy <br /> Cindy Thomson @ Insignia Sign Inc. CONTACT EMAIL: cthomson@insi i I's ign.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:76 Gas Station & Food Mart Contract Price of Worl. .i i '' V)QlIFY- <br /> Proposed Use of Building:76 Gas Station & Food Mart 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.1. ®Sign ❑Sprinkler tii •emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ®Reface existing 76 Pole Sign Cabinets(no structural changes//replacing faces only). <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 /> • <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water j !No.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 /> P ..... .# <br /> Ci �Tho#ndon (Contractor&Agent) 06/18/18 &C)(40 <br /> O O� - O` 0 <br /> Owner/AtRhorized Agent Signature Date (Revised 9/23/2016) <br /> (1 <br />