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� t�widing #y3ci � <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING 1 SIGN / II�INKLER/DEMOLlTION <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.govlpermits <br /> (Bfue or Blaek ink Only Pfease) PROJECT SITE INFORMATIQN <br /> PROJECT SITE ADDRESS: 9OO VII CtlSltlO RD, Everett, WA �S2O4 PROPERTY TAX#: 00392100000401 <br /> LEGAL for new construction: Sfiort PlaUsubdivision Lot No. {attach copy oi long legal descriptian) <br /> � CONTACT INFORMATION <br /> OWNER NAME: T ' Preservation LP TENANT NAME(!f Commercial): <br /> OWNER MAILING ADDRESS: S,�E� 21515 Hawthorne BLVD. Suite 390 <br /> �m Torrance STA,� WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNTw►cTOR NaNE: Holmberg Company <br /> CONTRACTOR ADDRESS: sTaEEr 1128 8th st <br /> �n„ Kirkland STA� WA Z+� 98033 <br /> CONTRACTOR PHONE: CONTRAGTOR EMAIL: <br /> CONTRACTOR UCENSE�l(REQUIRED): HOLMBC*066ME CITY OF EVEREIT BUSINESS LICENSE#(REQUIRED): Or'J�I 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRAGTOR ❑OTHER(Please Specify) <br /> CONTACT NAME. JaCOb KI@Itl CONTACT PHONE: 4.Zr'J-6OZ-737O <br /> CONTACT EMAIL: ,��cobK�hoimber co.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buiidin : Contract Price of Work:S 1400 <br /> Pro osed Use of Buildin : Heat Sourcer OGas ❑Electric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Rttached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro'ect: ❑New �Addition �Remodel �Re air �T.I. ❑Si n �S rinkler ODemolition ❑Chan e of Use <br /> OESCRIPTION OF WORK: 4L�'t-v��L- �t'or� �C+��v-'�'R�l G�,�q�, �aq,d� /�/� ��l��o� <br /> Gh�.��. .� � <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MECHANICAL PERMIT APPLICATION PI.UMBiNG PERMIT APPLICATION <br /> Type of Project: _New Addn X Alteration _Repair Type of Project: _New Addn AlteraHon _Repair <br /> #of List of Flxtures #of �st of FFirtores #°f tist of Fintures �°f tist of FJ�ures <br /> Fixtures Fixtures Ff�ures Flxturos <br /> A/C-Air Handlin Units Heat Pump Toilet Backfiow Preventer Inside Bid <br /> Forced Air S tems Unit Heater Bathtub Urinai <br /> Gas Pi " Boiler Lavato ash Basin i3rinkin Fountain <br /> Water Hea#er Refri eration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink 8�Dis osal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/BaNMo letc, dther: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed thls applfca6on and confimi the informaUon contafned herefn is true and correct.Wak done pursuant to this permit must comply wlth <br /> cument federaf,sfate,and local law.The g�anting of a permit onty authorizes appmved work and no deviations therefinm.Deviatlons must first be authorized in writing fram the <br /> Building Official before being authorized under any circumstanceJ am the owner,or!am authorized 6y the owner of thfs property to perform the work for whlch applicetion is made, <br /> and 1 comply with!he State Contractors taw 18.27 RGW and 296.200A WAC. <br /> CTty of Everett Officia!Use Only <br /> ���`G� �! �! 4 / PER� \�^ 'r O <br /> ( Y� 5 <br /> Own rlAuthorized As�e�rt Sipnature Date (Revised 9123I2016) <br />