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PERMIT APPLICATION� <br /> BUILDING ECHANICAL/ PLUMBING /SIGN ��INKLER/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 /> B�ae�r�la�r�nk ',+��1'���asu�����.� ��"`��' :� ��������N��►'� ��'€7 �K ,.�:�:.� _� <br /> � - .,fi , <br /> , m �� <br /> „, <br /> � �. � �� <br /> � <br /> ti�_, _ ...__ � . ..._n � � <br /> PROJECT SITE ADDRESS: 9OO W CaSII10 RD PROPERTY TAX#: 003g21-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �� - " ��" � "� �i���C�iNFORNIA��ON _ �_ `"' �.�'��,�,� -� � _ <br /> �t�1 '::��''$a'--3.,�_ Sc.mt ,e4 <br /> OWNER NAME: PaCKSICIe AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII'11�J@t' CO. <br /> CONTRACTOR ADDRESS: s�EEr 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJSZZZZ33 CONTRACTOR EMAIL: JaCObK@I10I111IJ2CgCO.COt11 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> v,.'- . '.- ' '4,q� r f.. h � . �."x�rk� ",s"" �".5..�S �.ta3�R',�*. .�•fi^ .:''r� -Y�.,,+G �-y` <br /> ��;�� , ���Bl���;���+IG�ERMIT APP��IC�►� � ���—�.��.���� �,��A s,�: <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed 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 /> uescRiPTioN oF woRK: Replacing Fixtures Like for Like with no Modification <br /> to Rough in. <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> �= r��YIECH�CNI��1L=��RIY�������.���1.�1�1.;:='��,�;r t =- _ �; �'LtlMB1,N1�'P,ERNII+T,.. ����n1+1�'��--`� .`M_ , <br /> Type of Project: _New Addn _Alteration _Repair Tyqe of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of ��st of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures 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 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 t� Sink(Service/Bar/Mop/etc.) Other: <br /> - _ SPRINK�L�R��S���ES�4,_l�, ���$��M�,�, � <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 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�cia/before being authorized under any circumstance.I am the owner,or I am authorized by the 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 /> PERMI]') �� �� <br /> Y �" <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />