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PERMIT APPLICATIOI� <br /> BUILDINC'"�ECHANICAL/ 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 /> ��I1i�D�i'���������/. ��S '�"`;���'���..����� ..� .��,���1��`��� b.��- � s�� � �,� -:.�� <br /> PROJECT SITE ADDRESS: 9OO W CaSlllO RD �'(p� PROPERTY TAX#: OOSJ2�-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> y � {� �, ����:� �� ;�_ � � �cor���eT�NF����►�r�o�`� ���`�� g� ������;� � � a. � � <br /> ,.�- ��.-.,a��'�.;:''��� �, �. .�a�,��.� �;�_ �t�^� �,.�. .�. s�- <br /> OWNER NAME: Pat'kSICI2 AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�eer 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOI11lb@f �'i0. <br /> CONTRACTOR ADDRESS: s�aeeT 1128 8th St E <br /> ��N Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJHZZZ`L33 CONTRACTOR EMAIL: �aCOIJK@II011llb@CgCO.COCTI <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OrJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> .��� ;� ��„ � �y°.�� �,� �,3 .� �7�G� �tMl �l L�� �,� O�+ � ��"���'�. ���`� �� � � � � �� � <br /> .b��� Z rv"�.5�«: -�.�*rs.,.�E.�.x^,.. �„"w�Y k,A.wz�':r. ,�.-> .5.,�,..r�,.�...1. ��x �L�' ��. ,����. r9.�.S„ ,t a�7"»gw x�c:X3� 'm.+'�zu.`l: �+�f__ ..-*�ii*Y <br /> .m,+.s.:Y;.. <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 ❑Du lex ❑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 /> t a.& d�','�ECi17!.�����...,v a.:7�!�����.��„�I,!]a�7.���R��:�„�.� ��.�... �d�.4 ���+��-���� . t�i!���,.�% .-,,,.��N�1�e„�.'� '.�iC� ��'',�r;-� <br /> R i�� <br /> Type of Project: _New Addn Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 4 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 4 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 /> �`� ���.\_�i�1�,���.� ...v.,.i��������1 J���` � � <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and con�rm the information contained herein is true and correct. Work done pursuant to this permif must comply with <br /> current federal,state,and loca/law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing f�om the <br /> Building O�cial before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereft Official Use Only <br /> PERMIT# +��/ _ _D� � <br /> � �/l.V�- <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />