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I Building #942 I <br /> PERMIT APPUCATIOI� . <br /> BUILDING I MECHANICAL/PLUMBING /SlGN I�INKLER 1 DEMdLlTEt3N <br /> C17Y OF EVERETT PERMIT SERVICES` <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (Pj 425-257-8810 ( FAX 425-257-8857 �{E}everetteps@eversttwa_gov� www.everettwa.gov/permits <br /> {Biue or Black Ink Only Piease) PR4JECT SITE INFOitMAT10N <br /> ��a.aEcr s�r�nuuREss: 940 W Gasino RD, Everett, WA 98204 P�op�Rnr TAx#: 003921 OOOOa4a1 <br /> LEGAL for new consfruction: Short PlatJsubdivision lot No. (attach copy of long legal description} <br /> CONTAGT fNFQRMATION <br /> QWNER NAM�: TCaIISICI@ PfeSGYVatlOtl LP TENANT NAME(If Commerciai): <br /> OWNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance ST,,,� WA Z� 90503 <br /> OWNER PHONE: 310-842-GsBZ OWNER EMI41L: Niek Preserva#ion artners.or <br /> coNrw►croR NnM�: Holmberg Company <br /> GONTRACTOR ADDRESS: s�ra�r 1128 8th st <br /> C�„� Kirkland STA� WA Z+P g80�3 <br /> CONTRACTOR PHONE: GONTRACTOR EMAIt: <br /> COh►TRAGTOR LICENSE#(REQUIREDj: HOLMB�i*O�6ME GITY OF EVEFtETt BUSINESS LICENSE#(REQFlIRED): UrJ'1 Oa3 <br /> PRlMARY GONTACTt 0 OWNE#2 �CONTRACTOR �OTHEEt{Please Specify) <br /> Ct?NTACT NA11AE: �aCOb KI81tl CQNTAGT PH�NE: �2'�J-�O2-���0 <br /> coNracT EMa�: J�cobK@h {mber eo.com <br /> BUILQING PERMIT APPLlCATION <br /> ExisUng Use of Buildin . Contract Price of Wo .S 2100 <br /> Pro sed Use af Buildin : Hea#Source: ❑Gas ❑Electri ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famii -#of Units: C1Commeroial ❑Industrial <br /> T of Pra'ect: ❑New C.�Addition ❑Remodel ClRe air �T.I. ❑Si n ❑S rinkler ❑Dernolition ❑Chan e of Use <br /> DESGRtP`CtON OF WORK: y,�,�,,.��,��, ,�-a� p�,,���,l,J, ,}�,� G�N 4�j �oA�O�'�, � L��'�� <br /> �h�.'�e�, U <br /> ASSOCIATED BUILDING PERM17# if a licable: <br /> MECHANICpL PERMIT APPLICATION PLUMBING PERMIT APP�.ICATION <br /> Type of Project: �New _ Addn X Alteration _Repair Type of Projectc _New _Addn _Alteratlon _Repair <br /> �°f tis!of Fixtures #of �st of�x#rrres #°f Lis!of FBrCures #Qf tist af�'i�c#ures <br /> flxiures Fucfures Ff�rfures Fixtures <br /> NG—Air Handlin Units Hea#Pump 7oilet Backflow Preventer Inside BEd <br /> Forced Air S #ems Unit Neater 8athtub Urina! <br /> Gas Pi i iler Lavato ash Basin Drinki Pour�fain <br /> Water'Heater Re ' eration Shower Fioor Drain <br /> Gas Fireplace W d Stove Kitchen Sink&Disposai Grease Tra ' <br /> Gas Ran e Du in Dishwasher Roof Drains <br /> Glothes D er Hooku s en Ctothes Washer Medicai Gas <br /> Ran e Hood Water Heater Uther: <br /> Exhaust Fan Sink(Service/BaNMo letc, Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKAtOWf.EDGEMENT.•I have reviewed thls appifcation and confirm the fnformation coMained herein is true and correct.Work dona pursuant to ihis perrnit must comply wJth <br /> curneni federat,state,and loca!law.The granting of a permit only authorizes approved work end no deviations thereirom.DevfaQons must first 6e etrthodzed in writing from the <br /> Buildrng Offrcial beiore being euthorrzed under any aircumstance.I em ihe owner,or!am authorized by the owner of th)s property to perfotm the woiJc for whlch appJicafion is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official t/se Only <br /> �/%1^� �/ � /�� PY `�\,'T � —�c <br /> Owner/AcrEh�ized As�ent Sipnatu�e Date lRevised 9/23/20t6) <br />