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PERMIT APPLICATIO� <br /> BUILDINOECHANICAL/ PLUMBING /SIGN � �RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> �< - -�.� <br /> ���+ ..�' �� � .�. � t� ��� �S V `F -��--� � - = <br /> PROJECT SITE ADDRESS: 9OO W CaSltlO RD �(J PROPERTY TAX#: 00392�-000-004-0� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> `i�t ��: - `�' -+i' . �r1`-�'-.. .�.'r`�'S --v y _ "�.. .',��f a'�Y�?-. �3,� _,.'�3+✓.� ... .�..- .3 zY... ,.._ . <br /> �5��#��.�. ���" ����,^ ,.a:--v- �� �`"'�'� y w` .-"'�';3"�`�s3'''� t"`�. w: �yp <br /> �.... <br /> h.�,c��"�Sb�Yr�,�:E' "4'm�.�".YZ�`uT.:�� �'--C ....p,�'�3,....':_. ��1���� � - �..,����: ��x �" . <br /> -./:;z r��i#':� .� .yS�a� ...a���` .M �� .,.f�w. <br /> OWNER NAME: PafICSICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�eEr 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII'T1IJ2C CiO. <br /> CONTRACTOR ADDRESS: s�eeT 1128 8th St E <br /> �m Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4ZrJ$ZZZZ33 CONTRACTOR EMAIL: JaCOIJK@h0II1lIJ2fgC0.COt11 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OrJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAILc <br /> .�...:��,'� «. ,�..�.,. ..-_ :7%�. .�-s;i>""��t _,.���';��'��. .z �'�k;.1::_,.,.�.a.. ,.>. N...,� . ,c,:a �,��, �'t�,� .�k-xr''�'�s'�r .�.c�..�.,. '>.y.,� a-�s':n'�..�» !''".. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replacing Fixtures Like for Like with no Modification <br /> to Rough in. <br /> ASSOCIATED BUILDING PERMIT# if applicable: <br /> F„� �'i�'�'�.,�"�ui���►�p�����o�����` �2�'� '��.�'�,. `�N��`;�e�n����� � _ - � <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 Fixfures <br /> A/C—Air Handling Units Heat Pump 4 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t� 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 t� Sink(Service/Bar/Mop/etc.) Other: <br /> �k�: .�.���.��E��`�QN������� �� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permif must comp/y wifh <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 Officia/before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this prope�ty to perform the work for which application is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> Cify of Everett O�cial Use Only <br /> PERMIT#/� �� O r,,,� D�� <br /> r �.� <br /> OwneNAuthorized Agent Signature Date (Revised 9/23/2016) <br />