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PERMIT APPLICATIO� <br /> BUILDINaECHANICAL/ PLUMBING /SIGN" �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 /> � <br /> ��i�e�r�Bia�ck�i„� ,nl . ��� e�� � ��cr�.��'���� ���`������" :�� �� - -,�_- ,���- F-. <br /> . �, � .v <br /> • Y <br /> , s. . ..,� ..._ : . -.. � x �._ �.m i. , � .�..� ». ,x � .. . m.� • <br /> PROJECT SITE ADDRESS: 9OO W CaSIC10 RD G(� b PROPERTY TAX#: 0039L1-OOO-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �a*• k ��"a, , s �- ;'�.„✓y�. .� �' �7 �..�3 t�+ �e � � �� ��`a�- :�S w �' - :- �X . <br /> y ��'S` '� � /� ■� ■ .YS. ? D td� FF <br /> E�i.>:. .o-a� �fi r_a, s,��-y�` ryf�.yl_���,A�^'Air`,''�.�������Y�'�,��� �t�A�l�1� t x fi .�r '� �`-'.'�i..� '�'' ht�.:_�� I 5�� � <br /> OWNER NAME: PaCI(SIC�2 AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�EeT 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII1lIJ@C CO. <br /> CONTRACTOR ADDRESS: s�eer 1128 8th St E <br /> �m Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJH2Z2Z33 CONTRACTOR EMAIL: .JaC�EJK@Il0II1lIJG'CgCO.COt11 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC�O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OGJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> hs y;^+. � a � �1�L�lI,+���-�E�tMlT�'PP41CA3'-10�1-,�� �*�z v�, `s��� t�-• �..,1 :�... � <br /> ,�$ �:r�.. �-x�.. -��x,•-x z'�k,�=.+�. ;_«..,. _.� .� �e�."�;_ -,�� .� �- <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#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 /> � ��nEc��i����►�����r.ii���°�����:� �����.� .., -�_� ; , � :�, ,p���st�t��,���i, ;�' ..�,;��°���,:�. k�� �� <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of Lisf of Fixtures #of �ist of Fixtures #of List of Fixfures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump t�. Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t� 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 Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan 4. Sink(Service/Bar/Mop/etc.) Other: <br /> �. �� S�RII��CL�R;�����R���.��� �`',.,r x' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> PERMIT#� �� �1 � I� <br /> U � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />