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PERMIT APPLICATIOI� <br /> BUILDINC�ECHANICAL/ PLUMBING /SIGN ' �RINKLER/ 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 /> �Biwe*o�'�lacl���lk�fltil �!�ea���e�' �,RO�ECT�Sl����+1����'O�1 t � �h r�- � '�- �`�`���"�:� "� �-�- ���`" ��,�� <br /> �.. �. ������ H.��� �...���- <br /> PROJECT SITE ADDRESS: 9OO W CaSIIlO RD � �1 K PROPERTY TAX#: 00392�-000-004-01 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> k �-� _ ��N��\I��l�i'�R�nIM���� - � - <br /> , .. : .. .. _ _ <br /> o . .; <br /> � , <br /> ..b „- • ... .., : ; . <br /> .,.. .. .. .�`..r.,.. ti<_ _... . . .,._.. . . ., .. . �. .. . .-. . �. _. , ... _.. .,-_..� . _� .., � .� ...�a_ <br /> t <br /> OWNER NAME: PaCICSICI2 AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�aeeT 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STA,� CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOI11lbeC �i0. <br /> CONTRACTOR ADDRESS: s�eer 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4ZrJHZ22Z33 CONTRACTOR EMAIL: �aC�IJK@I10I1'1'1�JePgCO.00111 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> � �ti � �-� +� •.�,� ����,y �y■ �,.y►�p �:` u�,. � r 3- �s-g� '�-r �� , � <br /> �`'' - '*'-��-�-. -r`� `�r " �VJ���]7ii.�-Y' ��Y. Y� �r } � -;�- .�-_=`��z_�`+-a.<�- <br /> �.-. .,...�xw.rze���.�-�� �sar�=��*"�.. � .���� � ..n-...v �.,..s`.��s�tt,,�-- ,.�s.a....�,.aK;�� 5' <br /> Existing Use of Building: Contract Price of Work:$ <br /> Pro osed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑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 /> = ��IAE��l1�11��1Ly�E�ty�11����L�iCATa�.�<..�} �. �: _�,�..�.�.-�'����`�B���P.,.ERMIT��►'P�PL��11��';��N.E��-_.�. .�:� ���; <br /> �.� .�_ <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of ��sf of Fixtures #of List of Fixtures #of ��st of Fixtures #of ��st of Fixfures <br /> Fixfures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 6 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 6 Sink(Service/Bar/Mop/etc. Other: <br /> �``�'����._F ��5���'�R�8�N'�S�'�1�M'��; <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and cor�ect.Work done pursuant to this permif must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authorized under any circumstance.1 am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Ciry of Everett O�cial Use Only <br /> PERMIT �� �P � � � <br /> U% <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />