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PERMIT APPLICATIOf"r <br /> BUILDIN� ECHANICAL/ PLUMBING !SIGN I I"�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 /> - <br /> ��iue��iack�l�k�O.�n1�t��ea�sej' -����E��«5�����1,����Q�1�'�� _ ��������� �,�-k��-��-..,�� <br /> PROJECT SITE ADDRESS: gOO W CaS1110 RD PROPERTY'TAX#: 0039Z1-OOO-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> i ��`tr '�`+4�"''"�' �' y �.s��"'-,. �!!rR���T�����.t �� `'-s� ,� �� "� ;�9�`��,�,,��ws au 4�� <br /> ( ,<:�.,r�a: a _u �` x�e s*.> ,.�,. ,t...,�, � �,.�x,:;,• <br /> OWNER NAME: PiiCkSICIe AC UISItI0C1 PC@SeCVc'.1tIOC1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTaEeT 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STA� CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIfT1IJ@C CO. <br /> CONTRACTOR ADDRESS: sTREET 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJHZ22Z33 CONTRACTOR EMAIL: .JaCOIJK@Il0It11IJ@CgCO.COCTI <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME 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 /> -�-�-�� � .�5 � -��- �� � �� ,�u n� -�,<• <br /> �. �..��,��_�. �- s�r�:���t��PEe�����„�.���►�i�H -� ,� - <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 ❑Sprink�er ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Replacing Fixtures Like for Like with no Modification <br /> to Rough in. <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> �.,:._��i�������►�.�.���i��►�p��c�ir�fl��,�..� .. �..,"��_����.�.�r�Bi�t����i�r�►���.�c��o,]�z���:`� �-�`.�;__� <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixfures #of List of Fixtures #�f Lisf of Fixtures #of List of Fixtures <br /> FixEures 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 4. Sink(Service/Bar/Mop/etc.) Other: <br /> `' `����311��L�R''��S�JP��ES_Sln�l�l�'S�'�E1111 '� . -.;' <br /> �..�.. �_ <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed fhis application and conflirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,stafe,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifing from the <br /> Building O�cial before being authorized under any circumstance.I am the owne�or I am authorized by the owner of this property fo perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Evereft Official Use Only <br /> PERMIT# ��/' �� <br /> V� � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016 <br />