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r ��� <br /> PERMIT APPLICATI� <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/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 /> {Blue or Black Ink On Please) PROJEGT SI�E INFORMATION ` <br /> PROJECT SITE ADDRESS: 9 �/ CaSIt10 R� , � � PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new constniction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> GONTACT INFORMATION <br /> OWNER NAME: Parkside Ac uisition Preservation TENANT NAME(If CommerciaQ: <br /> OWNER MAILING ADDRESS: STREET 21515 Hawthorne BLVD STE 395 <br /> �� Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIt11beC C0. <br /> CONTRACTOR ADDRESS: sTxeer 1128 8th St E <br /> ��TM Kirkland STATE WA ��P 98033 <br /> CONTRACTOR PHONE: 4258222233 CONTRACTOR EMAIL: JacobK@holmbergco.com <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066M E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '" ^ "� <br /> ��,� � CONTACT EMAIL: <br /> BUILDING PERMIT APPLtCAT10N ' <br /> Existin Use of Buildin : Contract Price of Work:S -� <br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Famil -#of Units: �Commercial ❑Industrial <br /> T pe of Pro'ect: ❑New �Addition �Remodel ❑Repair ❑T.I. ❑Si n OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MECHANICAL PERMIT APPLICATION ; PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteretfon _Repair Type of Project: _New _Addn _Alterat(on _Repair <br /> #of �/st of Fixtures #of List of Flxtures #of �/St of Flxtures #of �/st of Flxtures <br /> Ftxtures Fixtures Fixtures Ffxtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato Wash Basin Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease 7rap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hookups Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm!he information contained herein is true and correct.Work done pursuant to this permit must compty with <br /> current federal,state,and local law.The granting of a permit on/y authorizes epproved work and no deviations therefrom.Devlations must�rst be authorized in writing from the <br /> Building�cial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this propeRy to perform the work for which application is made, <br /> and I comply wRh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> PERMITt ��D �r �� <br /> l,Li �- <br /> /Autho M Signature Date (Revised 9/z:i/2016) <br />