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PERMIT APPLICATIOI—h <br /> BUILDIN ' ' CHANICAL I PLUMBING I SIGN I IIMINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps©everettwa.gov www.everettwa.gov/permits <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 /> CITY 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 ZIP 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 051003 <br /> PRIMARY CONTACT: ❑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:$ 5600 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached CI Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair On. OSign ❑Sprinkler ODemolition 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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 16 Toilet Backflow Preventer(Inside Bldg)' <br /> Forced Air Systems Unit Heater 1 F Bathtub Urinal <br /> Gas Piping Boiler 16 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 16 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 /> 16 Range Hood 16 Water Heater 2 Other: Hose Bibs <br /> 16 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <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.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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> - //77(7 <br /> PERMIT#rAOS 023 <br /> Owner/Authorized Anent Signature Date (Revised 9/23/2016) <br />