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� �ui�ding #y5�3 � <br /> PERMIT APP�ICATION <br /> BUILDING I IN�CHA�VICAL i PLUMBING /SlGN / �INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EV�RETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �{E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Biue or Biaak Ink Only Piease) PROJECT SITE INFORMATIQN <br /> PROJECT SITE ADDRESS: 9OO W C1SiC1Q RD, Everett, WA 9$204 PROPERTY fiAX#: 00392�OOQOO4O� <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach capy of lang legal description) <br /> CONTJACT INFORMATION <br /> OWNER NAME: Trailside Preservation LP TENANT NAME(!f Commercfal): <br /> OWNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �m Torrance STATE WA z� 90503 <br /> OWNER PHONE: 310-802-G68Z OWNER EMAIL: Nick Preservation artners.or <br /> coNTr�►croR N�E: Holmberg Company <br /> CONTRACTOR ADDRESS: sTaEer 1128 8th st <br /> ��„� Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: GONTI2ACTOR EMAIL: <br /> CONTRACTOR UCENSE#{REQUIRED): HOLMBC*O66ME CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): O�J1 OO� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME: �aCOI� KI@itl CONTACT PHONE: [1,2rj-��2-7�7� <br /> CONTACT EMAIL: JacobK@ho{mber co.com <br /> BUILDINt; PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:� 1400 <br /> Pro osed Use of Buildln : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ODu 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: ����,�� �o� �p,x.t�,�.� �M 4� �� 1� � ����a�' <br /> Gh�.��, �, ° <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn X Alteratfon _Repair Type of Project: _New Addn AlteraHon _Repair <br /> #af List of Fixtures #°f tfat of Ffxtures #of List of Fixttrres #oi ��yK�{Fixtures <br /> Fixtt�res Fixtures Ffar[uraes Flxtures <br /> A!C—Air Handiin Un(ts Heat Pump Toilet Bactcflow Preventer Inside Bid <br /> Forced Air S tems Unit Heater Bathtub Urinal <br /> Gas Pi in Bailer Lavato Wash Basin Drinkin Fountain <br /> Water Heater Refti eration Sh�nrer Fioor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink 8�Dis osal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Oiher. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/BadMo /etc. Other: <br /> SPRINKLER/SUPPRESSI�N SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have nevfewed thls application and confirm the informaUon contalned he�eln is true snd correct. Work done pursuant to ihis parmit must comply with <br /> current/ederal,state,and loca!law.The granting of a pennk only authorizes approved work and no deviations therefrom.Deviatlons must first be authorized in wriling from ihe <br /> Building Official befae being authorized under any circumstance.1 am the ownar,or 1 am authorized by the owner of thls property to perform the work for whlch applicafion is made, <br /> and!comply with the State Contraators f.aw 18.27 RCW and 296.200A WAC. <br /> CityoiEveisK Officisl Use Only <br /> � ,v��� PE MIT# —� <br /> �l <br /> Ow er/Authorized AAent Sic�nature Date (Revised 9/23/20l&) <br />