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� �unamg #y5z � <br /> PERMIT APPLICATION <br /> BUILDING �ILCHANIC�4L I PLUMBING/SlGN ! II�INKLER/ DEMOlIT10N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-881 fl � FAX 425-257-8857 �(E}everetteps@everethva.gov� www.everettwa.gov/permits <br /> (Biue or Black Ink Only Please) PRCJECT SITE INFORMATION <br /> PROJECT SITE ADDRES3: 9OO W CSSIf10 RD, Everett, WA 98204 pttoPeRnr Tax�: 00392100000401 <br /> LEGAL for new consfruction: Short PlaVsubdivision lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preservation LP TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,TM Torrance STATE WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNTRacroR NAnne: Holmberg Company <br /> CONTRACTOR ADDRESS: SIREET 1�28 Htll St <br /> �� Kirkland STATE WA =�P 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRAGTOR LICENSE#(RECIUIRED): HOLMBC*OGCME CITY OF EVERETT BUSINESS ti�GENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRAGTOR ❑OTHER{Please Specify) <br /> Cf)NTACT NAME: .JSCOb KIL'Itl CONTACT PHOM6; Q.Z�'J-�O�-73�0 <br /> CONTACT EMAIL: JaCOI�K@IIOIfYII?@C CO.com <br /> BUILDINt3 PERMIT APPLICATIQN <br /> Fadstin Use of Buildin : Contract Price of Wark:� 1400 <br /> Pro osed Use of Buildin : Heat Source: ❑Gas DElectric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du iex OMulti-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of P'ro'ect: ONew ❑Addition �Remodel ❑Re air ❑T.I. ❑5i n ❑S rinkler ❑Demalition L7Chan e of Use <br /> DESCRIPTION OF WORK: yGy��,`� �o�„� Lp,����,�� �x�� �� t�' � �, _`'•o� <br /> O •7'�+ <br /> GhF`��, <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMiT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn X Alteration _„_Repair Type of Projectt New Addn Alteration _Repair <br /> #of Llst of�xtures #of �st of�xtures #of List af�xtures #oi Lisf of Fintures <br /> �xtures Fixtures Ffxtures l�/xtures <br /> A!C—Air Handlin Units Heat Pump Toilet Backflow Preventer{Inside Bld ) <br /> Forced Air S tems Unif Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato ash Basin Drinki Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dis osal Grease Tre <br /> �Gas Range Ducting 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(ServiceBaNMo /etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed thls application and confirm the informetlon contalned herein Js true and correct.Work done pursuan!to this parmit must compiy wlth <br /> current federal,state,and/oca!law.The granting of a pennit only authorizes approved work and no deviations therefrom.DeviaUons must first be authorized in wrrting fiom the <br /> Building O/hciaf before being authorized under any circumstance.1 am the owner,or 1 am authorized by ihe owner of thls property ta pedam the work tor whtch applicetion is made, <br /> and!comply with the State Contractors Law 18.27 RCW end 296.200A WAC. <br /> City af Everett O�cial Use Only <br /> `�2� �r �/ r PE���� _'�� <br /> OwoerlAutho�ized Apent Sipnatu�e Date (Revised 9/23/2016) <br />