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I t�uuaing #yoci � <br /> I PERMIT APPLICATIOP� <br /> BUI�DING/�CHANICAL 1 PLUMBING /SIGN T�INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> {Pj 425-257-8810 � FAX 425-257-8857 ((E)everetteps@everettwa.gov� www.everettwa.govJpermits <br /> (Blue or Bisck Ink Only Piease) PROJEGT SITE INfORMATION <br /> PRo.�Ecr sir�aoo�ss 90Q V1l Casino RD, Everett, WA 9HZO4 PRr3PERTY'fAX#: 00392100000401 <br /> LEGAL fw new c�r+struction: Short PlaUsubdivision Lot No. (attach�py of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preserva#ion LP TENANT NAME(if Commercial}: <br /> OWNER MAIUNG ADDRESS: S,�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance STATE WA Z� 90503 <br /> OWNER PHONE: 310-802-fi682 OWNER EMAIL: Nick Preserva#ion artners.or <br /> coNrw►croR Nau�E: Ho{mberg Company <br /> CONTRACTOR ADDRESS: srn�Er 1128 8th st <br /> ��„� Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#{REQUIRED}: HOLMBC*OG6ME C1TY Of EVERE7T BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑OTHER(Please Specify) <br /> C�NTACT NAME: �aCOIJ �1I81t1 CONTACT PHONE: t�2�'j_�`j()2-]�]Q <br /> CONTACT EMAI�: ���obK�7a holmber co.com <br /> BUILDING PERMIT APPtICAT10N <br /> ExisUng Use af Buildin : Contract PHce ofi Work:� 1400 <br /> Pro sed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T : �SFR-�etached ❑SfiR-Attached ❑Du lex ❑Multi-Famii �of Units: ClCommercial ❑Industrial <br /> T of Pro'ect: ONew �Addition ORemodel ❑Re air OT.I. ❑Si n OS rinkler ❑Demotition ❑Chan e of Use <br /> DESCRIPTION OF WORK: yLl.,,, ��'� �,a� `pyC'�!�'�'n,,,, G�.,q�. L�oA��, �J P,��^�C'oCr <br /> G�•�.•��, ` �� •� v <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMIT APPL.ICATION PI.UMBING PERMIT APPLICATION <br /> Type of Project: _New Addn X Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #af Lfst of Ffxtures �°f List of Ff#ures #°; tist of Frx1`t�r+e.s �°f List of Fixtures <br /> Fixturea F'ixtures Fixtures Fi�ctures <br /> A/C—Ai�Handiin Units Heat Pump 7oilet Backflow Preventer Inside Bldg) <br /> Forced Air S tems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Refiti eratian Shower Floor Drain <br /> Gas Fire lace Wood Stove lGtchen Sink 8�Dis I Grease Tra <br /> Gas Ran e Ductin Dishwasher' Roo#Drains <br /> Clothes D er Hooku s Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBarlMop/etc. t�ther: <br /> SPRINKLER l SUPPRESSfON SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•!have reviewed this application and confirm the information contalned harein Is Uve and cawect.Wo�lc done pursuani to this permit must comply wlth <br /> curreni federaf,state,and iocal law.The granHng of e per+nit only authorizes approved work and no deviations therefrovn.Devfatans musi first be authorized in wrifing from the <br /> Building OflScial before being autho�ized under any crrctimstance.I am the owner,or!am authorizerl by fhe owne�af U�is prope�ty to pedorm the work for whlch applicafion is made, <br /> and/comply with the State Contractors taw i8.27 RCW and 296.200A WAC. <br /> Cky of Everett Official Use Only <br /> ` `�/ /�� p�il�l��3 --�2� <br /> OwnerlAuthorized Apent Si�nature Date lRevised 9123J2U16) <br />