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PERMIT APPLICATIOI� <br /> BUILDINC�CHANICAL/ 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 /> ��I�e�x:�lacky�nk��ly�lea�se������_��EE� �;���R��`�1i1����-�.��.�,���,�'�Y''������, ��� - <br /> � <br /> PROJECT SITE ADDRESS: 9OO W CaSlf10 RD �3 PROPERTY TAX#: OOS92�-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ./► ./►�" n �a-�, s �-- �' <br /> a L N �-. '�'"`�, '�s �-F- rae• _ �� � �;L���L7��11������ C; `�'`*'�.s -A �3t ,� .-li�.3. � <br /> 3v, s3a .%�.�z-'";.�. <br /> OWNER NAME: PafkSICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sixEer 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; Holmber CO. <br /> CONTRACTOR ADDRESS: sTaEEr 1128 8th St E <br /> ��n Kirkland STA� WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJHZZZZ33 CONTRACTOR EMAIL: JaCOIJK@IlOII71b@t'gCO.COCYI <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> 4�,�� � X� < � � . �.� , ;.r.�!#�;.-.,,,s ' �,'.' -�e. �, .� _ "'/�y �s .s �. �z:� �C'�,f �*��:1 5� Y aa^+':?.'�we:�#�� �'iL^r""a">. . <br /> C �µ �. , � yb� '�r` .y� i `�a. <br /> �`{ �, .t�._.;3.�r' � } . � d :". �..: .< <��n'��� b� °� ,s�'�Y.^�.������ ..�:n ...5� �rA�tiix't��S" ��'r.^',Y.e�. <br /> ,,�« ...���� J.y,u y�., 4 <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 /> T pe of Pro'ect: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e 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 /> ��'��'�EC1�IA�NICAL=-P�RMIT�►P.;P.�-1C�►�'�p�;=�� �_`��=" ���°:-��P„1��1l161N� PERNI17�1��P�..�;.�1�J�,������-���,�o�� ,� <br /> f <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of (,ist of Fixtures #of List of Fixtures #of ��st of Fixfures #°f List of Fixtures <br /> Fixtures Fixtures Fi�rtures Fixtures <br /> A/C—Air Handling Units Heat Pump 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 t� Sink(Service/Bar/Mop/etc.) Other: <br /> ��..���)�Ki�����r��iEs�r�bl��s����1��� <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 comp/y with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must�rst be authorized in writing from the <br /> Building O�cia/before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to pertorm the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Everett O�cial Use Only <br /> PERMIT� i� o� D�/� <br /> � is <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />