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� r�u�ia�ng �yi s � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN / =1NKLER I DEMOl.IT10N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 42�-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Oniy Plea ) PROdECT SITE INFORMATION <br /> PROJEGT SITE ADDR 0 W Casino RD, Everett, WA 98204 PROPERTY TAX#: 003�Z'I O000040'I <br /> LEGAL for new consfruction: PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TfaIISICIB Pf@S@tVatlOtl LP TENANT NAME(!f Cammercial): <br /> OWNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance STATE WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNrRacTOR NaMe: Hoimberg Company <br /> CONTRACTOR ADDRESS: srnEEr 1128 8th st <br /> �m Kirkland STATE WA Z� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LfCENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LIGENSE#(REQUIRED): OS1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTI4GT NAME: CONTACT PHONE: t�2rj-602-7370 <br /> Jacob Klein <br /> coNrncr eMa�: ,lacobK�holm�er co.com <br /> Bt�ILDIN6 PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:S 1400 <br /> Pro osed Use of Buildin : Heat Source: ❑Gas �Electric ❑Other <br /> Buildin T : OSFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: �Commercial ❑Industrial <br /> T e of Pro'ect: ClNew (�Addition ORemodet ❑Re air ❑T.I. OSi n �S rinkler ❑Demolition ❑Chan e of Use <br /> OESCRIPTION OF WORK: �L�yp�� �o� ����,�.,,,. �„4� �� l� ,!.,, ���•o�- <br /> Gh���. �:.s �� o ��:� <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMtT APPLICATION PLUMBIN6 PERMIT AP'PLICATION <br /> Type of Project: _New Addn X Atteration _Repair Type of Project. New Addn Alterallon _Repair <br /> #of tist of Fixtures #of �#af Fixtures #°f List of Ffirtures �°f List of Fixtures <br /> Fixtares Fixtures Ffxtures Flxtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S tems Unit iieater 8athtub Urinal <br /> Gas Pi in Boiler kavato ash Basin Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitahen SinK&Dis osal Grease Tra <br /> Gas Ran e Ducting Dishwasher 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/Bar/Mo /etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•!have reviewed thls applicaGon and confirm the informstion conlalned herefn!s true and correct. Work done pursuan[to this parmit must comply wlth <br /> current/ederaf,state,and local law.The granting of a pe�mit onty authorizes approved work and no deviations therefrom.DeviatJons mus!first be authorrzed in writing from the <br /> Building O/ficial before being authorized under any circumstance.l am the owner,or 1 am authorized by the owner of thls property to perform the work for whlch application is made, <br /> and J comply with!he State Confractors Law 18.27 RCW snd 296.200A WAC. <br /> City of Fver�sft O/ficiat Use Only <br /> ��` ��7/c P RM,� 3 -- 0 <br /> Owne uthorized AAent Si�nature Date (Revised 9I23/2Q16) <br />