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� t3ui�ding #yzo � <br /> PERMIT APPLICATION <br /> BUILDlNG/MECHANICAL I PLUMBING /SlGN /�INKLER/ DEM��ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEQAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> (Blue or B1ack tnk Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 900 W Casino RD, Everett, �A�$2�4 PROPERTY TAX#: 00392100000401 <br /> LEGAL for new construction: Short PlaUsubdivision lot No. {attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TCaIISICIB PC@S@N��IOtI LP TENANT NAME(If Commeraial): <br /> OINNER MAILING ADDRESS: S,�E� 21515 �lawthorne BLVD. Suite 390 <br /> �,� Torrance STA1E WA Z� 90503 <br /> OWNER PHONE: 3'I O-HOZ-6fi82 OWNER EMAIL: Nick Preservation artners.or <br /> coNTw►cTOR Nnr��: Holmberg Company <br /> CONTRACTOR ADDRESS: STREET 1128 8th st <br /> c�rr Kirkland sra� WA ziP 98033 <br /> CONTRACTOR PHONE: CONTItACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J�I 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Speciiy) <br /> CONTACT NAME: JaCOI� KI@ill CONTACT PHONE: Q.ZrJ-�OZ-737O <br /> CONTAGT EMAIL: ,lacobK�a holmber co.com <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:� 1400 <br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached �Du lex �Multi-Famil -#of Units: ❑Commercial �Industrial <br /> T of Pro'ect: �New OAddition ❑Remodel �Re air OT.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: yL�p�� ��� ���[,�R� �x�� �� l S. � ���o� <br /> Gr•�.►��. ...� ° <br /> ASSOCIATED BUILbiNG PERMIT# if a licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: �New _ Addn X Alteration _Rapair Type of Project: _New Addn Alteration _Repalr <br /> #of tist of Fixtures �°f LFst of FFxtores #of Lfst of Ffxfures ��f list af fixfures <br /> fixtures Furtures fixtures Flxtures <br /> AJC—Air Handlin Units Heat Pump Toilet Backflow PreveMer Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Urinal <br /> Gas Pi i Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Refi eration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink 8�Dis osal: Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other. Clothes Washer Medicai Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/BaNMo letc. Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.!have revlewed this applicaUon and connrm the in/ormetlon contalned herein!s true snd correat.Work done pursusni to this permit must cwnpiy with <br /> cument federsl,state,and loca!lew.The granting of e permit only authorizes approved work and no deviations ther+efrom.Deviatlons must first 6e euthorized in wrifing fiom the <br /> Building Offecia/before berng authorized under any ctrcumstance.1 sm the owner,or 1 am authorized by ihe owner of this prope�ty to peAorm!he work for whlch applicetion is made, <br /> and J comply with the Stafe Contractors Law 18.27 RCW and 295.200A WAE. <br /> City of Everett Official Use Only <br /> , <br /> `r /��C P��IT � � O� 1 <br /> Owner/Authorized As�ent Sipnature Date (Revised 9/23/2016) <br />