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� �una�ng #y4� � <br /> �I.I- PERMIT APPLICATION <br /> BUILDING llll�cHANICAL/PLUMBING /SlGN /�NKLER/ DEMOLITI4N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 9$201 <br /> (P)425-257-8810 � FAX 425-257-8857 �{E}everetteps@everettwa.gov� www.everettwa.govipermits <br /> {Blue or Biack Ink Only Piease) PROJECT SITE INPORMATIQN <br /> PRo�ec�r sire aoaREss: 900 W Casino RD, Everett, WA 98204 PROPERTY TAX#: 00392'I OOOQO4O'� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preservation LP TENANT NAME(!f Commercial): <br /> OWNER MAIUNG ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,TM Torrance STATE WA Z�P 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNT�►cTOR Na�e: Holmberg Company <br /> CONTRACTOR ADbRESS: STREET 1128 8th st <br /> �� Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTFtACTOR UCENSE#{REQUIRED): HOLMBC*O�6ME CITY OF EVERETi BUSINESS LIGENSE#(REQUIREDj: O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME: CONTACT PHONE; 4'2rj-FQZ-737O <br /> Jacob Klein <br /> CONTACT EMAIL: JaC0�1K�IlOICP1I3G'Y co.com <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin : Contract P�ice of Work:S 1400 <br /> Pro sed Use of Buildin : Heat Source: ❑Gas ❑Elsctric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition �Remodel ❑Re air ❑T.I. ❑Si n OS rinkler ❑Demolition ❑Chan e of Use <br /> OESCRIPTION OF WORK: c,L����L .�('a�„� �p,X��L�,�.n„ G�N 4�j �oA t S, � P��'o�- <br /> Gh�.��. � � ° <br /> ASSOCIATED BUILDING PERMtT# if a licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> fiype of Project: New Addn X Alterat�on _Repair Type of ProJect: New Addn Alteration _Repair <br /> #of tFst of Fixtures #�f Lfst of Fixte�res #of ��st of Ffxtures #°f list of fixtures <br /> Fi�ctures Fixfures Ffactures Flxtures <br /> AIC—Air Handlin Units Heat Pump 7oilet Backflow Preverrter Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Unnal <br /> Gas Pi in Boiler Lavato asfi Basin Drinkin Fountain <br /> Water Heater ftefri eration Shower Floor Drain <br /> Gas Fireplace Woad Stove Kitchen Sink&Dis osal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mo /etc. �ther: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMEN7:•I have revlewed thls appffcaUon and confirm the fnformation contalned herefn ls true and correct. Work done pursuanf to this permif must comply with <br /> cument federel,state,and focal Iaw.The granting of a permit only authorizes approved work and no deviations there/rom.Deviatlons must Brst 6e etithorized in writing from the <br /> Building Of�rcia!before being authorized vnder any circumstance.1 am the owner,or!am authorized 6y the owne�of th/s property to perform the work for whlch application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett 0lficiaf Use Only <br /> � �/��� PE� � �L"C � <br /> � <br /> OwneNAutho►ized Aaent Slpnatu�e Date (Revised 9/23/2016) <br />