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� t3unding #y�ci � <br /> PERMIT APPLICATION <br /> BUILDING/I1�IECHANICAL/PLUMBING 1 SIGN / I I�INKLER 1 DEMOL.ITION <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 /> (Blue or Black lek Oniy Pfease) PROJECT SITE INFORMATION <br /> PROJEC�SITE ADDRESS. 9O{a IN GaSlftO RD, Everett, WA 98204 p�zoPEtrnr TAx�: 00392100000401 <br /> IEGAL for new construction: Sfiort Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preserva#ion LP TENANT NAME{if Commercial): <br /> OWNER MAII.ING ADDRESS: S,�E� 21515 Hawthorne B�VD. Suite 390 <br /> �,� Torrance STATE WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNTwe►cTOR NaME: Holmberg Company <br /> CONTRACTOR ADDRESS: srne�r 1128 8th st <br /> �� Kirkland STA,� WA =� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRAC70R L.ICEtrSE#{REQUIREOj: HOLMBC*066ME CITY OF EVfRE7T BUSINESS I.ICENSE#(RECUIRED): O�J�I OOS <br /> PRIMARY CONTAC7: ❑OWNER �CONTRAGTOR ❑OTHER{Please Specify) <br /> CONTAGT NAME: Jc"�COIJ ICI�'Itl Cf�NTACT PHONE; 1�2�j=6��-]37Q <br /> CONTACT EMAII: J$�OIJK�r10It11IJ@C CO.com <br /> BUlLDING PERMIT APPLICATION <br /> E�asting Use of Buiidin : Contract P�ice of Work:S 1400 <br /> Pro osed Use of 8uildin : Heat Source: ❑Gas DElectric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du fex ❑Multi-Famii -#of Units: ❑Commercial �Industrial <br /> T e of Pro'ect: ❑New ❑Addition ❑Remodei �Re air ❑T.I. ❑Si n ❑S rinkier ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �G�p�� �o� ����,�.�� �M 4� 1 � l�, � �+ _,'a� <br /> v� O �1'� <br /> Gh���, � <br /> ASSOCIATED BUlLDING PERMIT# if a licable: <br /> MECHANICAL PERMIT APPLICATION PLUMBiNG PERMIT APPLICATION <br /> Type of Project: New Addn X Alteration _Repair Type of Project: New Addn _Alterallon _Repair <br /> #of List of Fixtu�es �°f List of Fi�ures #of �jst of fixtures �°f List of Flxtures <br /> Fi�ures Fixtures Ffxtures Flxtures <br /> A/C—Air liandii Units Heat Pump Toilet Backflow Preventer Inside Bid <br /> Forced Air 5 tems Unit Heater Bathtub Urinai <br /> Gas Pi in 8oiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Reiri eration Shower Fioor Drain <br /> Ges Fire lace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku Other: Glothes Washer Medicat Gas <br /> Ran e Haod Water Heater Other: <br /> Exhaust Fan Sink(ServicelBariMopletc, Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemica!or Water No.of Heads <br /> ACKNOWLEDGEMENT:•I have reviewed this applicaGo»and confirm the informatfon contalned irerefn Is true and correct.Work done pursuant to thrs permit must comply with <br /> current federal,state,and locat few.The granting of a pem�it only authorizes appro+red work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Ofhtiai before being authorized under any circumstance.I am the owner,or!am authorized by the owner of thfs properfy to perform the wo�lc for whlch application is made, <br /> and!compJy wFth!he State Conlractors Law 1$.27 RCW and 296.200A WAC. <br /> City of Evereit Officiai Use Only <br /> �/� `�/��/c� p11v�T� , �2 <br /> Owner/Authorized A�ent Si�tnature Date lRevised 9/23/2Q96) <br />