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PERMIT APPLICATIO <br /> BUILDINaECHANICAL/ PLUMBING/SIGN��RINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC�S <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 /> ��1.�+��o.,.�B�ac�c�nl,c�..�.+�-�.+��5��R���-� ��-�.��-������ ���� �-: - -�-�.� - -<� <br /> PROJECT SITE ADDRESS: 9OO W CaS1110 RD �� � PROPERTY TAX#: 0039`L�-000-004-0� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �ti�� � �� � � �� x � �- �n "��.w� �� � <br /> ��: .�� `��' � y'�`�` '� � ,� �'w� > ��, ��� '' £�`*' �--� '� <br /> ,+���. .��*s.x ��ri�"n .. _�._ra- .�;�..K� ��� �T� !l+7.��K '' �>�'�;= h.�t�mfi7� ,..:ka.:�..,..�-� �%...,.;.'. . <br /> OWNER NAME: PaCkSICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STA� CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII'TtIJ@C CiO. <br /> CONTRACTOR ADDRESS: sTaEEr � 1 ZH Htll St E <br /> �� Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Zrj$2ZZ2$$ CONTRACTOR EMAIL: �aCOI�K@I10ICTlIJEfgCO.COCT1 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OJ�003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ����;� � � ������� . <br /> �,: <br /> r.. :,.,.�- ...:.. �, ._...�.r .,.�_ ..,'k�^�a..r n.:...�W��'�.;�.Y.�„'.a:.`';... ,.e��.�. �.�'y.,. ..:�.. . .�. .. A;.�. � . �'.;`�x��+-r��. �` �` ..,w�; 4,..���f ;.�4.:a�= <br /> Existing Use of Building: Contract Price of Work:$ ' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Ty e: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replacing Fixtures Like for Like with no Modification <br /> to Rough in. <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> � ��I11�C�A�!�.� �..,��,`P;P��i���'����� ,��` ����.� ������'�N� <br /> �._ � `� � �`• <br /> , s� ,x,- , _ .,� ..�.. . . :�.. >_. _. . <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of Lisf of Fi�ctures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 4 Toilet Backflow Preventer(Inside Bldg <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 4 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan 4 Sink(Service/Bar/Mop/etc. Other: <br /> �_"���������� ����Pr�. _ ��:n���5�. <br /> d . <br /> y <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and/oca/law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must flirst be authorized in writing from the <br /> Building O�cial 6efore being autho�zed under any circumstance.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> PERMIT# �i '�� <br /> vo <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />