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PERMIT APPLICATIO�■ <br /> BUILDIN�ECHANICAL/ PLUMBING /SIGN" �RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (�'}425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wuvw.everettwa.gov/permits <br /> , p �, � <br /> � � <br /> . <br /> ��l�e�r�l�ac�:������'�#, :.. �,�'����t�y�1�,�C���.- ,��� ° ��� � <br /> �: f � .: ,. <br /> ..�- - �, .r .�-,_ 2,:�- ��, , � _ <br /> PROJECT SITE ADDRESS: 9OO W CaSIf10 RD � PROPERTY TAX#: 0039`L1-OOO-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> :;- �:: �{x'�, �..� �- �"�'> ' - ,, �`}�`�`� �' �;� s�*"*�S r .�': s�v' .":��'� -�- � {:, '�. <br /> , _ -� _;;�� :caN�r`�►c��������`���� �..: ��.��.�x..F-��. <br /> OWNER NAME: PICICSICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rREET 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIIIII�@f CO. <br /> CONTRACTOR ADDRESS: STREET 1128 8th St E <br /> ��n Kirkland STA,� WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJH22ZL33 CONTRACTOR EMAIL: JaCOIJK@IIOIPYlIJ2PgC0.COf1'1 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME 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 /> $��,,��-�,�;s���'€����r������^��;: �1����E �� �.�s, � > ��� �����4..�F"� -�. c,� <br /> ;��. <br /> - s- _ . <br /> ' --� � � . � ... ._.. .... _ .,..._,.. <br /> ^� 7 <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas �Electric ❑Other <br /> Buildin Ty e: ❑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 /> ..�� . . - <br /> � x_: v� �����1���R�l�`-�l��L�I�ATION `�° r; � *���` �� �B �.�������,��t���r� � ���. <br /> �,- �_. �_... _�_ . . . _� _. . �:-: ,,. .� m� s^,.�... ,. _ . . . . ��`�-�;..;� <br /> .� ��� <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 Fixfures #of ��st of Fixfures <br /> Fixtures Fixtures Fixtures Fiartures <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 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 4 Sink'(Service/Bar/Mop/etc.) Other: <br /> "�` � ,�,�����S��N�'5��1"�E11�1 ;��'{�; <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 fhis 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 O�cial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> PERMIT ^ /� <br /> U <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />