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� t�w�ding �ySU � <br /> PERMIT APPLICATION <br /> BUILDING / CHANICAL/PLUMBING /SlGN 1�INKLER/ DEMOLITION <br /> GI7Y OF EVERETf 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 /> (Blue or Black Ink On1y Please) PRIfJECT SITE INFORMATI�N <br /> PROJEC7 SITE ADDRESS: gOO W Cc'�SitlO RD, Everett, ��►982�� PROPERTY TAX#: 00392100000401 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TCaIISICIB PI'eSeNatfO►1 LP TENANT NAME(If Commerciai): <br /> OWNER MAIUNG ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,TM Torrance STA,� WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNTw�►cTOR Nawe: Holmberg Company <br /> CONTRACTOR ADDRESS: sTneer 1128 $th st <br /> �� Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PNONEc CONTRACTOR EMAIL: <br /> CONTRACT4)R UCENSE#{REGIUIRED): HOLMBG*Q66ME CITY OF EVERETT BUSINESS UCENSE#(REQUIR�D): OrJ1 003 <br /> PRIMARY CONTACT: �OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CdNTACT NAME: J�COI� Klelft CONTACT PHONE: t1,2rj-�OQ-7$7� <br /> CONTACT EMAIL: JaCOI�K CY IIOII'1'1I361' CO.com <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin : Contract PHce of Work:S 1400 <br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T : ❑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 ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �,G,\„ —�� ���„� �,p,x��[,�.�,� �„4� �� i S. ,l.,.. �� _r�°�- <br /> T,�9 V �V�, ��� <br /> Grh��, � <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn X Alterafion _Repair Type of ProJect: _New Addn AlteraHon _Repair <br /> #of List of Frxtures #°f List of�xtures #of List of Ffxtures #of List of Fixtures <br /> Fi�ures �xtures Ffxtures Flxtures <br /> AIC—Air Handiin Units Heat Pump Toilet Backflow Preventer Inside Bid <br /> Forced Air S tems Unit Heater 8athtub Urinal <br /> Gas Pi in Boiler Lavato ash Basin Drinki Fountain <br /> Water Heater Retri eration Shower Ftoor Drain <br /> as Fireplace Woad Stove Kitchen Sink&Dis osal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other. Glothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink ServiceBar/Mo /etc, Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this applfcation and confirm the information contalned herefn/s We snd conect.Wak done pursuani to this permR must comply with <br /> current federel,state,and locai law.The granting of a permR only authorizes approved work and no deviafions therefrom.Deviadons must ffrst be euthorized in writrng from the <br /> Building Olficial before being authorized under any circumsiance.!am ihe owner,or i am authorized 6y ihe owner of this propedy to perlorm the wak for whlch applicetion is made, <br /> and i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett OfBciaJ Use Only <br /> � 1�! �/ � � PERMIT#� ,o V� <br /> .,. ,*;; <br /> ner/Authorized Apent Sipnature Date (Revised 8/23/2016) <br />