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� t3undmg #y�U � <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING 1 SlGN/ I �tINK�ER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3204 CEDAR STREET,EVERETT,WA 9$20'1 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E}everetteps@everettwa.gov� www.evereriwa.gov/permits <br /> (Blue or Black lnk Only Please) PROJECT SITE INFORMATION <br /> PRo�Ecr si�aoQ�ss: 900 W Casino RD, Everett, WA 98204 PROPERTY TAX#: 00392100000401 <br /> LEGAL for new construc#ion: Short PlaUsubdivision Lot No. {attach copy oi long legal description) <br /> CONTACT INFORMATIGN <br /> OWNER NAME: TI'aIISICIG' PY@S@fVa#IOtI LP TENANT NAME{If Commercialj: <br /> OWNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance STA,� WA Z�P 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preserva#ion artners.or <br /> coNT�►cTOR NaME: Holmberg Company <br /> CONTRACTOR ADDRESS: srn� 1128 8th st <br /> ��„r Kirkland STA� WA Z�P 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR UCENSE#(REQUIREDj: HOLMBC*066ME ClTY OF EVERETT BUSINESS UCENSE#(REQUIRED): OrJ�003 <br /> PWMARY CONTAC7: ❑OWNER �CoNTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME; ��COb KI(.'It1 CONTACT PHONE: 1�2J-6(��-]�]'� <br /> CONTACT EMAIL: �acobK@holmber co.00111 <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of 8uilding: Contract P�ice of Work:# 1400 <br /> Pro sed Use of Buildin : Heat Source: ❑Gas DElectric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil �of Units: ❑Commercial ❑Industrial <br /> T of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re ai� ❑T.I. ❑Si n ❑S rinkler ❑Demolitfon ❑Chan e of Use <br /> DESCRIPTIONOFWORK: �,G�p�� ,�or� �(+�j'�'R.� �.,y� �Qq�s �/CJ (��tt��o� <br /> Gh�.'��, v v <br /> ASSOCIATED BUILDING PERMIT# if a ticable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project. New Addn X Alteration _Repair Type of Project: _New Addn _Alteratlon Repair <br /> #of List of�ixtures #°f LFat of Ffxtures #°f List of Ffxtunes �°f L)st of Fixtures <br /> Fixtures Fixtures �ixtures Flxtures <br /> A/C—Air Handlin Units Hea#Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S tems Unit Fieater Bathtub Urinal <br /> Gas Pi in Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink 8�Disposal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Glothes D er Hooku s Other. Clothes Washer Medical Gas <br /> Range Hood Water Hea#er Other: <br /> Exhaust Fan Sink Service/BaNMop/eic. Uther: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.o,f Heads <br /> ACKNOWLEDGEMEN7:•f have reviewed thls appticaGon and confirm the information conteined hereln!s true and conect.Wak done pursuant to this parmk must comply wlth <br /> cument/ederal,state,and locaf law.The granting of a pennit only authorizes approved work and no deviations therefrom.Devlations musi frrst be euthorized in writing from the <br /> Bui/ding Oh5cial beiore being authorized under any cfrcumstance.1 am the owner,or!am authorized by ihe owner of thls propeKy to perform the work for whlch application is made, <br /> and!comply with the State Confractors taw i8.27 RCW and 296.200A WAC. ' <br /> Ciry of Fverett Officisl Use Only <br /> f�%�/J� � /7/ r""j PEF�I�lI�#�O ��vv <br /> So � � � � �v " <br /> OwnedAuthorized Anent SiAnature Date tRevised 912 312 0 1 6) <br />