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PERMIT APPLICATIOhr� <br /> BUILDIN(�CHANICAL/ PLUMBING /SIGN I II 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 /> ��iue�o,�l���k���/��,���.��„� �� r_����i�����,��,.������ �� -- �- �� � __ -�, ,�� ��-. <br /> PROJECT SITE ADDRESS: 9OO W CaSIC10 RD (, PROPERTY TAX#: OOS9Z'I-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �"�- a.._.,-.� 3 ��,�.,.�. �.xr c � �.-.�. -� � <br /> �:. ,�. `�<�.r�-�. ,��F _-.:�-��� ,����.,�CbN�'���';�NFO�M�'��D�I'4�` ��'� �� ��������z��'-� ��,M`_�,�= <br /> OWNER NAME: Pclt'kSICIe AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srnee-r 21515 Hawthorne BLVD STE 395 <br /> �� Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIIT1I�e1' Co. <br /> CONTRACTOR ADDRESS: sixE� 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJHZZ2Z33 CONTRACTOR EMAIL: .JaCOIJK�U I10I171I�2fgC0.COt11 <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 /> �- ,��"� " .��:h i��.�.K��,� � �� �1 � ,�.�'�#'i������1�.� :;� �..��.t�,�x< ,� �n��� <br /> Existing Use of Building: Contract Price of Work:$ <br /> Pro osed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building T pe: ❑SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Famil -#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 /> � : �n�c��cb�.��.�� _.�.�:�'�.��:►�,�r������" � . �T ���i,u�s����� � "������F�f� ���. <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of ��st of Fixfures #of ��sf of Fixtures #of ��st of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AlC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Q. 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 brains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan 4 Sink(Service/Bar/Mo /etc.) Other: <br /> � ��'SPR1�'��.��t-���P��. _.�� �}�...� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confi�m the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and/ocal 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�cia/before being authorized under any circumstance.1 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 compty with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everetf Official Use Only <br /> PERMIT# ��0�� � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />