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PERMIT APPLICATIO�. <br /> BUILDINaECHANICAL/ 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 /> � s -�,�; ��, -� �, �.�«� <br /> , _.-,x. �_ _ <br /> ���$ � <br /> PROJECT SITE ADDRESS: 9OO W CaSIC10 RD �Q(� PROPERTY TAX#: 00392�-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �� . � , � � �~��������,.� � � �.�,,�i►■� +. <br /> , <br /> �x <br /> � � <br /> :�.«ti ._ ';�.�:�� _'����., -i",s,�:� r� ��.`�`��*.e".B�.2'.n-�"g,.n�.�"�'..i� � . .r, u �:., ., a�,i� � �ir <br /> . ��- M F��.,. <br /> , . <br /> vu_, � <br /> OWNER NAME: PaCFCSICIe AC UISItIOCI PI'@S@CVc'3tl0tl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�EeT 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STA� CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIf1lIJ@C C0. <br /> CONTRACTOR ADDRESS: STREET 1 12H Htll St E <br /> o�n Kirkland STA,� WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'JrH2ZZ233 CONTRACTOR EMAIL: .JaCOIJK@Il0IC1lI�@fgCO.COtII <br /> GONTRACTOR LICENSE#(REQUIRED): HOLMBC*O6CME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> _ ,� <br /> �� . � :s����,�,����,_�:,�.��,.�_. . ��.,�. � k��� :.� s��°� ��, <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 ofPro'ect: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Replacing Fixtures Like for Like with no Modification <br /> to Rough in. <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> �.�e�.� gP����,,, �����Ii1�1T�#��� �,��,�; � .��`.:��������M� <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteratian _Repair <br /> #of List of fixtures #of List of Fixtures #of Lisf af Fixtures #of List of Fixtures <br /> Fixtures Fixfures Fintures Fi�ctures <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 4 Lavatory(Wash Basin) Drinking Fountain <br /> VVater Neater Refrigeration Shower FloorDrain <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 /> '�:r�<*a. ��� ���Y��� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information confained herein is true and correct.Work done pursuant to this permif must comp/y with <br /> current federal,state,and/ocaf 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 O�cial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property fo perform the work for which application is made, <br /> and 1 comply wifh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT � <br /> f�l o(�'DOt� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />