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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> "IiPs#11144 ":4- <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 off-BIac Int OniVPlea$e) PROJECT SITE;INF RMAT1ON T .M , r u r,', ,2 <br /> PROJECT SITE ADDRESS: 10627 19TH AVE SE, EVERETT PROPERTY TAX#: 00445600003100 <br /> LEGAL for new construction:'Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> !_ 4 , ,,CONTACT;INFORMATIONr" {w =ir. >'<, <br /> - <., "�� �... � �. , h5 �. , r, ;5� f x P .,ail 5. �5p, i + ,... ,�`x <br /> OWNER NAME: BEC BUILD LLC TENANT NAME(If Commercial): COOLEY SMILES DENTISTRY <br /> OWNER MAILING ADDRESS: STREET 18031 67TH AVE NE <br /> CITY KENMORE STATE WA ZIP 98028 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: TUBE ART GROUP <br /> CONTRACTOR ADDRESS: STREET 11715 SE 5TH ST <br /> ciTY BELLEVUE STATE WA ZIP 98005 <br /> CONTRACTOR PHONE: 206.679.8732 CONTRACTOR EMAIL: Shawnb@tubeart.Com <br /> CONTRACTOR LICENSE#(REQUIRED): CC TUBEAD*31 1 QS CITY OF EVERETT BUSINESS LICENSE#(REQUIR..): 006667 <br /> PRIMARY CONTACT: ❑OWNER p CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206.679.8732 <br /> SHAWN BOWEN CONTACT EMAIL: ShaWnb@t .Com <br /> ; � , � ;, 'BUILDING;PERMIT APLICATIIOI� .'` 5a ", ... l ,i <br /> .. e.. I�'�! 17 na-+t Ka., �' .�. �Ma.t abs.�§«s?�..,c� .Y"�. x� t _. � � � d � v� � � !t. <br /> Existing Use of Building:Commercial Contract Price of Wo :$5500 <br /> Proposed Use of Building:Commercial Heat Source: OGas DEI ric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: IRCommercial ❑Industrial <br /> Type of Project: ONew DAddition DRemodel DRepair CIT.!. IRSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Install Illuminated Monument Sign <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 'MECHANICAL PERMIT'A PLICATifGN , ;' 5PLU_MBING PER 11T iAPPLICATION <br /> e G y <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 /> SPRI,NKLERI SUPPRESSION _SYSTEM R}! <br /> Chemical or Water I 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 /> ill , / <br /> CityofEverett Official Use Only <br /> 9/ /fPE MI1\# l VO9 r 0`-� <br /> 0 , :i/Authorized Agent Signature Date (Revised 9/23/2016) <br /> df.;) <br />