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13?'‘\ PERMIT APPLICATIO <br /> BUILDINJ*IIIECHANICAL/PLUMBING I SIGN 1VP RINKLER I DEMOLITION <br /> 011/fr----41 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everettepsteverettwa.gov www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1300 100th PI SE A, Everett, WA 98208 PROPERTY TAX#: 28051900101700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preservation LP TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 21515 Hawthorne BLVD. Suite 390 <br /> env Torrance STATE WA ZIP 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick@Preservationpartners.org <br /> CONTRACTOR NAME: Holmberg Company <br /> CONTRACTOR ADDRESS: STREET 1128 8th St <br /> CITY Kirkland STATE WA ZAP 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 051003 <br /> PRIMARY CONTACT: D OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Jacob Klein CONTACT PHONE: 425-602-7370 <br /> CONTACT EMAIL: JacobK@holmbergco.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 4200 <br /> Proposed Use of Building: Heat Source: OGas El Electric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑.Commercial DIndustrial <br /> Type of Project: DNew DAddition ❑Remodel DRepair DT.I. DSign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: Duct Work from range hoods only. New exhaust Fans not Provided or installed by <br /> US. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn X 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 12 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 12 Bathtub Urinal <br /> Gas Piping Boiler 12 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 18 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 /> 12 Range Hood 12 Water Heater 2 Other: Hose Bibs <br /> 12 Exhaust Fan Sink(Service/Bar/Mop/eta) 4 Other: ADA Showers <br /> SPRINKLER I SUPPRESSION SYSTEM <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.lam the owner,or 1 am authorized by the owner of this property 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 Official Use Only <br /> f"*"/" C77(7/ PERZt 0 t. 6:1 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />