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� t�u�ia�ng #y�4 � <br /> IIIIIIII PERMIT APPLICATION <br /> BUILDING /MECHANICAL 1 PLUMBING/SIGN/ -1NKLER i DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (Pj 425-257-8810 � FAX 425-257-8857 J(E)everetteps@everettwa.gov� vvww.everettwa.govlpermits <br /> (Blue or Black 1nk Only Piease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �OO W Ca51f10 RD, Everett, WA 98204 PROPERTY TAX#: 0039Z�O000040� <br /> LEGAL for new construction: Shork PlaVsubdivision Lot No. (attacb oopy oi long legal description) <br /> CONTACT INFf�RMATION <br /> OWNER NAME: TYaIISICI@ PCBS6NatlOtl LP TENANT NAME{!fi Commercial): <br /> OYVNER MAIUNG ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance STA7E WA Z�P 90503 <br /> OWNER PHONE: 310-802-fi682 OWNER EMAIL: Nick Preservation artners.or <br /> coNrw�croR NaME: Hoimberg Company <br /> CONTRACTOR ADDRESS: SIREET 1128 8th st <br /> �� Kirkland STA,� WA Z� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CON7'RACTOR LICENSE#{REQUlRED): HOLMBC*066ME CITY Of EWEitETT BU3IWESS LICEMSE#(REQUIRED): O�J1 OO.� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: JaCab �{�eln CONTACT PIiONE: 1�2rj-6�2-7370 <br /> CONTACT EMAIL: ,��cobK@holmber co.com <br /> BUILDING PERMIT APPLICATiQN <br /> Existin Use of Buildin : Contract Price of Work:S 1400 <br /> Pro sed Use of Buildin : Heat Source: OGas OElec#ric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition �Remode! ❑Re air ❑T.i. ❑Si n �S rinkler ❑Demo}ition OChan e of Use <br /> DESCRIPTION OF WORK: y�,��`� ,�,�� �i�,r,J,�.R,� �„5� ���� � �-��•oC� <br /> Gh���. ,r..� <br /> ASSOCIATED BUILDING PERMIT# if a ticable: <br /> MECHANICAL PERMIT APPLICATION PI.UMBING PERMlT APPl.ICATION <br /> Type of Project; New Addn X Alteration _„_Repair Type of Projectc _New _At1dn Altention _Repatr <br /> #of List of Fixtures #of �st of�xtures #of ust of Fixteir+es �of List of Fixtures <br /> Fixtures Fixfures Ffxtures FiGrtures <br /> A/C—Air Handlin Units Heat Pump 7oilet Backflow Preventer Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Urinal <br /> Gas Pi i Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Reiri eration Shower F1oor Drain <br /> Gas Fire lace Waod Stove Kitchen Sink 8�Dis osal Grease Tra <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Glothes D er Hooku Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Neater Other: <br /> Exhaust Fan Sink Service/Bar/Mo etc. Other: <br /> SPRINKLER 1 SUPPRESSI�N SYSTEM <br /> Chemical or Water No.of Head's <br /> ACKNOWLEDGEMENT:/have r+eviewed thls appffcation and confirm the information contained herein Is We and conect.Wak done purauant to this permit must comply wlth <br /> cument federal,state,enA locaf!ew The granting of e pem�it only authorizes approved work and no deviations therefmm.Deviatrons must first be authorized in wiiting fiom the <br /> Buifding Official befone being authaized under any circumstance.1 em the owner,or/am authorized by ihe owner of thfs prnperty to perform the work for whlch application is made, <br /> and J camply with the State Contractors Lew 18.27 RCW and 296.200A WAC. <br /> Ciry of Everett Official Use Only <br /> ' � �?/� PERMlT# , O <br /> � <br /> OwnerlAuthorized As�eM Sipna#ure Date lRevised 9/23I20l6) <br />