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� t�unding �yzz � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING !S1GN / �INKLER/ DEMO�ITIQN <br /> Cli'Y C7F EVEFtETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 9$201 <br /> (P)425-257-881U { FAX 425-257-8857 �(E}everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue ar Biack Ink�nly Please) PROJECT SITE INPORMATION <br /> PRO,IECT SITE ADDRESS: 9OO IN CaSitlO RD, Everett, WA 98204 PROPERTY TAX#: 003921000004�1 <br /> L�GAL for new constn�ction: Short PlaUsubdivision Lot No. (attach copy of long legai description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preservation LP TENANT NAME{!f Commercfai): <br /> OYVNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance STA,� WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNrw�croR N,v�E: Holmberg Company <br /> CONTRACTOR ADDRESS: STREET 1128 8t�t s# <br /> �m Kirkland STATE WA Z� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE il(REQUIREb): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTFtACTOR ❑OTHER(Please Specify) <br /> GONTACT NAME: J�COIJ KI@itl CON7ACT PHONE: L�2�j-6O�-]�]� <br /> CON7ACT EMAIL: JaCOfJK�Q �'IOII'Ylb@I' CO.com <br /> BUILDIN6 PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Prtce of Work:; 1400 <br /> Pro sed Use of Buildin : Heat Source: OGas ClElectric ❑Other <br /> Buildin T : �SFR-Detached ❑SFR-Attached ❑Du lex OMulti-Famil -#of Units: ❑Commercial ❑Indus#rial <br /> T e of Pro'ect: ClNew ❑Addition ❑Remodei ❑R air �T.I. ❑Si n ❑S rinkler ❑Demolition OChan e of Use <br /> DESCRIPTION OF WORK: �G�„�p�� �a� �{,1,�,�.R �� � t '� <br /> Gr.�..��, � 5e- � oS. ,� P,�� ar <br /> ASSOCIATED BUILDING 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 Alteration _Repair <br /> #of tist of Fbrtures #of �t of Fixtures #°f List oiFlxtures �°f List af Fixtures <br /> Fixtures Fixtures Fixtnres Flxtures <br /> AJC—Air Handfin Units Heat Pump Toilet Backflow Preventer(Inside Bid <br /> Forced Air S tems Unit Fleater 8athtub Urina1 <br /> Gas Pi in Bc�iler Lavato ash Basin Drinkin Fountain <br /> Water Heater Reiri era#ion Shower Floar Drain <br /> Gas Fire lace Wood Stave Kitchen Sink&Dis osal Grease Tra <br /> Gas Ran e Ductin 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 ServiceBar/Mo /etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�!have reviewed thls applfcaGon end carfirm the informalion contafned herefn Is true and correct.Work done pursuani to this perrnif nwst comply with <br /> cuirent federal,state,and local law.The granting of a pem�it only authorizes approved worh and no deviatrons therefrom.Deviations must first be aulhorized in wi+ting fmm the <br /> Buildrng Officiat before being authorized under any+circumstance.!am the owmer,or 1 em authndzed 6y tha owner of thls propeKy to perform the wark for whlch applicetion is mede, <br /> and!comply wiUr the State Contractors Law 18.27 RCW and 296.2a0A WAC. <br /> City of Everett OfficiaJ Use Only <br /> ���( �� �� PEl `� l l� J ' D J <br /> Owner/ uthorized A ent Sipnature Date tRevised 9/23/2016) <br />