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��� <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANlCAL!Pi.UMBING/SIGN !SPRiNKLER t DEM4LITI4N <br /> CtTY OF EVEi2ETT PERMET SERVICES <br /> 3200 CEDAR STREET,�VERET'�,WA 98241 <br /> (P}425-257-8810 � FAX 425-257-8857 �(E)everetteps�everetiwra.gov� www.everettwa.govlpermifs <br /> Blue or Blaak Ink Onfy Please PROJECT SITE INFORMATtON <br /> PRO.lECT SPfE ACDRESS: W Casir�o RD �rto��nr rax#: t�03921-Ot}0-�04-01 <br /> LE[#AL fa new cnnstruction: 8hort U t n Lot No. (attech copy of lang Eegal desc�ipUon} <br /> .;. , . . <br /> • CONTACT IN�ORMATION <br /> OWNER NAME: ��}'�SiC�� AC UlSltil(3f1 F�CE5G'i"'Vc'�t10C] T'ENANT NAME([f CnmmerCial): <br /> OWNER MAILINl3 ADDRES$: STR£ET 21515 Hawtharne �LVd STE 395 <br /> cmr TOCC�nC� srn� CA z�P 9050� <br /> OWNER PHONE: OWNER EMAIL: <br /> COMfRACTpR NAME; Hc�imber C0. <br /> CQNTRACTOR AdDRES$: 6„� 1 i 28 8th St E <br /> crrv K�rkl�nd srn� ll1iA z�a 98033 <br /> CONTRACTOR PHONE: 42�8222233 CONTRAGTQR EMAIL: J�C0�3K�7a}�plCt't��t'C'�CO.COf'f'11 <br /> co�rr�►c7oa uceNSE�EQui�). HOLMBC'�066ME C1TY QF EVERETT BElSINE$S LICEN$E�/{R�QUIRED}: 051003 <br /> PRIMARY CON7ACT: 0 OWNER �CONTRACTOR O OTHER(Please Specify) <br /> COM'ACT l�A1AE: CONTACT PHONE: <br /> CpNTACT EMAIL• <br /> . BUILDINi3 PLRM#T APPLICATI�N ` . , , <br /> Exisii Use of Bui�in : Co�rtract Price of Worlc; <br /> Pro osed Use of Buildin : Heat Souroe: �7Gas ❑ElectNc DOther <br /> Buildi T : �SFR-Detached �3FR Atteched Opu ex I�Multi-Fami -#of Units: �IComm�cfal ❑fndustdal <br /> T of P ect ❑f�few 1�Additlon �Remodel ORe ir �T.I. DS n OS rinkter ODemolition OChan e of Use <br /> C1�SC[tIPTION OF WORK: <br /> Replacir�g Two Toilets and Lavataries <br /> �3 � c�o� -a2�-- <br /> $OCIAIED BUICDINt3 P�RMIT# ft a Ifcable: <br /> ;.;MECNANlCAL PERMIT APPLICATION PLUMBINL�PERMIT APPLICATION ' <br /> Typs of Project: �New ,_,_„ Addn � AIleratlon _ltepalr Type of Projeet: _New _Addn _Alteration _Rep�ir <br /> F�v� List of Flxturea �� Lkt of F►xtwss �� L)st of Flxkrrss ��� ttst of Fixfuros <br /> AlC–Air Handlin Units lieat Pum 2 Toilet Backflow Preventer Inside Bld <br /> Forced Air tems Unit iieater 9athtub Urinat <br /> Gas Pipin Boiler � Lavata ash BasM Drinkin Famtain <br /> Water Heater Refri erati� Shower Floor Drain <br /> G2s Fir ce Wood 5tove Kitchen Slnk&Disp�al Grease Tra <br /> Gas Ran e Ductln Dtshwasher Roaf Drains <br /> Ciothes D er Hoaku s Otl�er: Clothes Washer Medical Gas <br /> Ra Hood Water Heater Other. <br /> Exhausf Fan Sink Senrice/BarlM /etc. Qther: <br /> aPRINKLER l SUPPRESSION aVSTEM <br /> Chemicat ar Water No.of Head6 <br /> acruuowLEDGeMen�r.�1 naw revfewed Nris eppltr.eeton m,d�arrrm the mromret+o►r conra�err nerebr/s rrue a�,a colre�warly dare pu.a�,ant ro thls pe.►Mr en�ar oomply►�fh <br /> crurent fede�l,atste,ond/oee!taw.The grnnHng�a pemut anJy authalzes sppro�red wwk and no davlatJons therefiam AevteUons must Rrst be authadzed in wriffng Irom the <br /> BuUd7r�g OHlcial betore ba/ng evUioAzed undar any aNcumsteru�.I am tha owner,or!am authorized by the owner o/tlils property to perlam the wak�or whlch appNcetion hr meda, <br /> and!corr�fy wkh the Steie Co�Gactas Lew l8.27 RCW and 296.24QA WAC. <br /> � /�� /� CI(y of Eversit OA4cla!Use Only <br /> / � <br /> r ! � P�T � — �l �J <br /> ClwnerlAuthorhee gnature Dete (RevJaed 9/23l'2016j <br />