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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 /> ,�� ��< <br /> �8it�e,�r�sl,acic��� a . ,�!s�e��.,��� `� �°�E��'�,��r. ��,�aV1�1►�;��i�����: �, �` °'�rA <br /> _.� _ <br /> x. . �.....,_� �... � � .�.,, - � <br /> PROJECT SITE ADDRESS: 9OO W CaS1110 RD �j PROPERTY TAX#: 0039Z1-OOO-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> - �_; - � - � �,��-'.���O.N���'����`�t�1A�10N, � � �����,��`��� ��{� ��` - <br /> � r - <br /> :,. :. i Y . .�. i' '.� '. _ <br /> r' ,_ .�. ' .' _ <br /> ��_s . . _ . ...� .�n �-, > _... c,...e..�v�. v__ ._�. ,� v �i�.. <br /> ; . <br /> - ��a.K.`���"w+.� <br /> OWNER NAME: Parl(SICI@ AC UISItIOft Pf8S2fVatlOtl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�xEET 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STA� CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII'1lIJ2f CO. <br /> CONTRACTOR ADDRESS: s�xeET 1128 8th St E <br /> ��n Kirkland STA,� WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJS2ZZ233 CONTRACTOR EMAIL: .Jc1C0I�K@hOICT1I�@CgCO.COtII <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME 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 /> _ <br /> K.=�_._-��y .'. ,... " ,.._. �� �:,�z .`�:..__����..,.���������1�'��P�.I�A��flN <-������,����`����;�,�.� <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: �Commerciai ❑Industrial <br /> Type of Project: ❑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 ap licable : <br /> , ,� � <br /> �,.': �Y�IIIE�HA1�11��1t�P,��M,������ ._� _...t, �� r� �""��.�MB1�1G,'�,��'�Il��� ;_�., �, `��=.�� �� <br /> :� <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #of ��st of Fixtures #°f List of Fixfures #of 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 WaterHeater Other: <br /> Exhaust Fan 4 Sink(Service/Bar/Mop/etc.) Other: <br /> � �'�SP�tiNK'L��t���l�'�'�S� � <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I 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 local 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�ciaf before being aufhorized 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 comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everetf Official Use Only <br /> PERMIT�1� `' � D�� <br /> v�,�r <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />