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� �u�ia�ng #y4o � <br /> PERMIT APPLICATION <br /> BUILDING�HANICAL I PLUMBING/S1GN /� I IINKLER/DEMOLlT10N <br /> CI7Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 '(E)everetteps@everettwa.gov� www.everettwe.govlpermits <br /> (Blue or Black Ink Only Please) PRfiJECT SITE INPORMATIGN <br /> PROJECT SITE ADDRESS: 90Q W Casino RD, Everett, WA 98204 PROPERTY TAX#: 0039Z')O000040'� <br /> LEGAL for new construction: Sfiort Plat/subdivision Lot No. (attach copy of long legal descriptionj <br /> CONTACT INFORMATION <br /> OWNER NAME: TCaIISiCI@ Pt'@S@Na'IIOtI LP TENANT NAME(If Commercial): � <br /> OWNER MAIUNG ADDRESS: S,�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Tarrance STATE WA Z�P 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNrRncroa NnME: Holmberg Company <br /> CONTRACTOR ADDRESS: STREET 1128 8th st <br /> ��„� Kirkland STA� WA Z+P 98033 <br /> CONTRACTOR PHOHE: CONTRACTOR EMAIL: <br /> CONTRACTOR UCENSE#{REQUIRED): HOLMBC*066ME CITY OF EVERE7T BUSINESS LICENSE#{REQUIREDJ: OS1 003 <br /> PRIMARY C(}NTACT: ❑pWNER �GONTRACTOR ❑OTHER(Please Specifyj <br /> CONTACT NAME: CON7ACT PHONE: 425-602-7370 <br /> Jacab Klein <br /> coNracT EMa�: ,lacobK@holmber co.com <br /> BUILDING PERMIT APPLfGAT10N <br /> Existing Use of Buildin : Contract Price of Work:S 1400 <br /> Rro sed Use of Buildin : Heat Source: ❑Gas �Electric �Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: �Commeroial ❑Industrial <br /> T of Pra'ect: �New �Addition C1Remodel C1Re air OT.I. ❑Si n ❑S rinklsr ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: yL�,.V,P`� ,�,�� ���l.�,�.�,,, G�h 4�,.� v�oA�s. � P��'o� <br /> Ghti`�p�. J v <br /> ASSOCIATED BWLDING PERMIT# if a licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: _New Addn X Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #af Lfst of F'�xtures #of ��af Fixturres #of List of Flutt�res �°f Llst of Fixtures <br /> Fixtores Fixtures Ff�ures Flxtures <br /> A!C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Urinai <br /> Gas Pi in Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Reiri eration Shower Floor Drain <br /> Gas Fire lace Wood 5tove Kitchen Sink 8�Dis osal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other. Clathes 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 /> ACKIVOWLEDGEMENT:I have r+eviewed thls applfcaUon and confirm the fnformeUon contafned herein!s true end correct.Wak done pursuant to this permit must comply w!!h <br /> cwrent federal,state,and loca!law.The granting of a pennit only authorizes approved work and no deviations therefrom.Deviations must Srst 6e authorized in wrifing from the <br /> Building O/hcial beiore being euthorized under any circumstance.f am the owner,or!am authorized by the owner of thls property fo perform the►+mrk for whlch applicafion is made, <br /> and I comply with the State Contrectors Law 18.27 RCW and 296.200A WAC. <br /> CRy of Everatt Official Use Only <br /> �;�%'l� ������ Pr v �T� �"� ` <br /> OwnertAuthorized Apent Sipnature Date (Revised 9/23I2016) <br />