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PERMIT APPLICATIOI� <br /> BUILDIN(�F:�CHANICAL/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 /> ��1we�or�Bi�ck�!►���►�����������-�"��.��������������'���.������ --,,,� � � E�_�. <br /> � � ,� � <br /> PROJECT SITE ADDRESS: 9OO W Cc1Sl(10 RD � '�j O PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> � � � � � ��� �{ � �' ��.s�.w � � ��� � �' � � � � <br /> S S ''s'� Y 4 "& ��i?�2:'�������Ft��N�T�01� �'��K33� t�, F�$� '�'3 '���+ . '�� d <br /> a ::;�, z..s- � � a ?,� �, - � .a;�.�s .�`�< .€�� �,�..t�-.�+F."a�?r ^-.r.�.�:�, <br /> OWNER NAME: Pc1CKSICJG' AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII'1'IIJG'C CiO. <br /> CONTRACTOR ADDRESS: STREET 1128 8th St E <br /> �� Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 42'rJHZZZ2S3 CONTRACTOR EMAIL: Jc1C0I�K@IlOIt11IJe1'gCO.COfII <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> � .�� � ,� �. � � ,, :,���.<„�� ���-ER s1�����L-��A'TIO�+I � � � �'�v����,,��€.���.x��w <br /> Existing Use of Building: Contract Price of Work:$ <br /> Pro osed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#ofUnits: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. �Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> �escRiPrioN oF woRK: Replacing Fixtures Like for Like with no Modification <br /> to Rough in. <br /> ASSOCIATED BUILDING PERMIT# if a plicable : <br /> ,:� `-�`��NIE�H�►NICAL�LLER�II�T`fiA�'���`�A'�,��1J� �. �_.�..�,m`' a�>�P1.�fi�'IB1NG���RN�1��►��f�lM � �-,�,� ����� <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 Lisf of Fiutures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixfures <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 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 /> � � �`�Si��tINKLERI�SUPT�tES3��� ,,.�, , � }: <br /> �.� ..,�:>�_�.�.�.r <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 comp/y with <br /> current federal,state,and local law.The granfing 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.!am the owner,or/am authorized by fhe owner of fhis property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# �� � �� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />