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�una� �i4 <br /> PERMIT APPLICATION <br /> ING/MECHANICAL/PLUMBING /SlGN I �INKLER/ DEMO�ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320q CEDAR STREET,EVERETT,WA 9$201 <br /> � � (P)425-257-8810 � FAX 425-257-8857 �(E}everetteps@everettwa.gov� wavw.everettwa.gov/permits <br /> (Slue or Black ink Only Piea ) PROJECT SITE INFORMATION <br /> PRaecT si�aoo�ss: W Casino RD, Everett, WA 98204 PROPERTY TAX#: 00392�O000040'I <br /> LEGAL for new construction: Sfiort PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TCc'�IISICI@ PCeSGNatI0t1 LP TENANT NAME(If Cotttmercial): <br /> OWNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> Cm Torrance STATE WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNTw►croR NnME: Hoimberg Company <br /> CONTRACTOR ADDRESS: srneEr 1128 8th st <br /> �m, Kirkland STA,� WA =� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LiCENSE#(REQUIRED): HOLMBC*O6CME CITY OF EVERE7T BUSIHESS LICENSE#(REQUIREb}: OS�I 003 <br /> PRIMARY CONTAC7: O OWNER �C�NTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME: Jacob Klein CONTACT PHONE: L�ZS-GOZ-7�7O <br /> CONTACT EMAIL: ,lacobKQa holmber co.com <br /> BUILDING PERMlT AP'PLICATIQN <br /> E�stin Use of Buildin : Contract Price of Work:� 1400 <br /> Pro sed Use of Buildin : Heat Source: ❑Gas ❑Electric �Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famii �of Units: �Commercial ❑Industrial <br /> T of Pro'ect: ONew �Addition ❑Remodel ❑Re air �T.i. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: yG�v�� ��rn �;l.�,�.n_„ G�h 4(� v�oAds 1v�.� °���+�'o� <br /> Gh�.��. � � <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANIC�IL PERMIT APPLICATION PLUMBING PERMIT APPI.ICATION <br /> Type of Project: _New _ Addn X Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List af Fixtures #of �st of Fixtures #of Llst of Fixtures �of List of�xtures <br /> Fixtur�es Furtures Fixtures Ftxtures <br /> AJG—Ai�Handli Units Heat Pump 7oilet Backflow Preventer(Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Urinai <br /> Gas Pi in Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Refi eration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Dis osai Grease Tre <br /> Gas Ran e Ductin Rishwasher Roof Drains <br /> Clothes D er Hooku s Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/BarlMo letc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.!have revfewed thls applicaGon and confirm the informetion contained hereln ls true and correct,Wak done pursuant to ihis permit must comply with <br /> current federal,state,and locat law. The grar+ting of a permit only authorizes approved work and no deviafions the�efrom.Deviations must Tirst be authorized in writing from ihe <br /> Bui/ding OhScia!before being suthorized under any clrcumstance.l am the owner,or i am authorized by the owne�of thfs properfy to perlorm the wo�lc for whlch application is made, <br /> and I comply wkh!he State Confractors Law 18.27 RCW end 296.200A WAC. <br /> City of Everett Officesi Use Only <br /> . � ��/ � PERMIT# �� ��\ ^ J <br /> � �-� <br /> OwnerlAuthorized t�ent Sipnature Date (Revised 9/23/2016) <br />