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PERMIT APPLICATIOI"r <br /> BUILDIN�ECHANICAL/ PLUMBING /SIGN I' I'FRINKLER/ 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 /> �C�tue��Black�lnk-�3nl���ieas��. �"�� �,�RjO�������N��tN1���OJaI����,�-,�� ��.������y_ �� ����: <br /> PROJECT SITE ADDRESS: 9OO W Cc'�SItlO RD PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> z � � � .� = R�IN �- �� n.`" � <br /> :_ . v , � <br /> E,r �.._ �: _.. : _ .- ,- .. > �` "���iTA`CT li��fl� , �►TI�N � � � � -� <br /> OWNER NAME: PaCkSICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srRE� 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIIllIJ2f C0. <br /> CONTRACTOR ADDRESS: srneer 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4ZJrHZ2ZZ3S CONTRACTOR EMAIL: .JaCOI�K@IIOII'Tlb@CgCO.COfTI <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OrJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> � =��� �. ���. 4_�= ` '�� "� ��,111. �il�r �t �� ��,��'�C�'��fiO��r �� � '�� ;�;� �����;��x x <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 /> DESCRIPTION OF WORK: <br /> Replacing Fixtures Like for Like with no Modification <br /> to Rough in. <br /> ASSOCIATED BUILDING PERMIT#(if applicable : <br /> ��`:v�'�.�'�V�,EC�l�I►N��AL�aPE�t11111T�,�;P1.��T�l��N;�,� ����.�`��.�'�`� ��1.�7N�B��G'P�RMIT'�,'��'1;I�t��,�'���1 �,:.� „���. <br /> . ��. w <br /> ks <br /> ' .,�;., . <br /> . _ .... � „ _ .., � .. � �M . . __. . .�.. .. o �.._ ,... .�.. , � <br /> �_, <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of Lisf of Fixtures #of List of Fixtures #of ��st of Fixtures #of Lisf of Fixtures <br /> Fixtuies 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 F2ange 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 /> E ��s����K��R��uPP��ss����� �� �k�� �� <br /> .���x:� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and con�rm 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�cial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this 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# � ����'1/� <br /> ��f <br /> � � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016J <br />