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PERMIT APPLICATIOf"r <br /> BUILDIN�ECHANICAL/ 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 /> _ �_ _ <br /> . � <br /> . �-_ <br /> . <br /> �$11���Dr'�Iac�c�,11f��!�;��eB�S��<.-.�,. ,_A:_ �,�: ����.� �� �►�'1���.�� «�� � r�,.,.. <br /> PROJECT S�TE ADDRESS: 9OO W CaSltlO RD �(� PROPERTY TAX#: 00392�-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot Na (attach copy of long legal description) <br /> � _ �. � � �� �� ��.� ��`���.�'�C��,���b��111A�-1�N� a;� �.��`��' ���-�.'���..��.�-��.�'���.��. <br /> �� � ,_. ..��- _,,�-� <br /> OWNER NAME: PaCI(SICI@ AC UISItIOCI PYG'SeCVa'CIOiI TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�xeeT 21515 Hawthorne BLVD STE 395 <br /> �� Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOICYlIJ2f CO. <br /> CONTRACTOR ADDRESS: s�xEEr 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 42'rJHZZ2Z33 CONTRACTOR EMAIL: JaCOIJK@Il0It11EJG'CgCO.COCTI <br /> CONTRACTOR LICENSE#(REQUIRED): HQLMBC*O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ��-mrca-��.��_ � ��:-- � ��� �� .,� �,:;-�� �, - ._ � s� � - <br /> �-§ ,.,�� ������ ��`� :�<��.. ��' ����0��5�,s�.._.� �s.��s�:�:,. ���t.'-`�.�.�a_:�:;-: <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industriai <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 /> F f,��lVIEC�1��IlCA�"P;ER�YII�'...�'�1� ��a� ��.����'° _, r r�IUMB�ii�aG`P;�EI�NIIT�.��_, _�►.'.�,� j�,��'r���`� <br /> . � <br /> ..� �__�,.. �.1 . : ,..w . ,._�_.- <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteration Repair <br /> #of List of Fixtures #of List of Fi�cfures #of Lisf of Fixtures #of List of Fixtures <br /> Fiarfures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtu6 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(Seroice/Bar/Mop/etc.) Other: <br /> �����PRI��S��it���.l������..g_,� �'� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm fhe information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must firsf be authorized in writing from the <br /> Building O�cia/before being aufhorized 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT l^��'�� ' <br /> b <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />