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PERMIT APPLICATIOI�i <br /> BUILDING ECHANICAL/ PLUMBING /SIGN I'I�tINKLER/ 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 /> � �.7 <br /> {�l�e�r;�l .�-;i� ,�1��"���s��`��-�' =���"� E���'�l�'�� `�t�lif O.I+1 ����:����= - =-�-��.¢ ��2,�§���-�� <br /> �,�,_� �... . �_ ... . _o .� _,. , �. _ r, .. .�. _ , _ � . <br /> PROJECT SITE ADDRESS: 9OO W CaSIC10 RD �pCJ PROPert�nr ra�c#: 003921-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ; ; �" x ' ;�� ��€'�„� <br /> �K �s ,JG��1'T�#C-��`�NF��t1111A'1'�QN ���:'� x 3,.� ��-�`�-� ; ��,. �-�,�� �-< <br /> �. - - � f.., .��'.�.,�.. x�. #� <br /> OWNER NAME: P1fkSICI@ AC UISItIOII Pf@S@IVatI0C1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�eeT 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIIIIIJ@r C0. <br /> CONTRACTOR ADDRESS: s�eET 1 �2H $tIl St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJHZZZ2S3 CONTRACTOR EMAIL: .JaCOI�KQU IIOltllb@CgCO.COiII <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ^_ � : ...T '�. �.: ,� � �` -" � �� 'a:s� � '�^�.�. ;34r� -z�rt,.. .` �-. . <br /> � ':,.u� .. -.. , J 1 �; ,r k,� ��: e.����"'� ...F,.,�'��.,,.z,w�,. �..,��-��G�'��1����°,P�;+1.iG�4�lD��, � ;�-�� �_���; �-�"�f��„�;,��-�:�:. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commerciai ❑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 ap licable: <br /> @ .�hEc��►��t�t:��,�n�i����,��a.�i`�'� ��".�,.-�; _����.: y�-�k'� ��.�u.n�B���� ���r � ��� �� -��� <br /> � ...�. �,���.: � f� ��, ,�`�.�.����. <br /> Type of Project: _New Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of ��st of Fixtures #°f List of Fixtures #of List of Fiufures <br /> Fixtures Fi�ctures Fixfures Fixtures <br /> A/C—Air Handling Units Heat Pump 4 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 /> , ':_ _'°�PR1�KLfR/��UPPI�ESS��'��.���S�IIi rt��,��' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and conflirm 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/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# i a/' O 1 <br /> d �%�� i✓ <br /> OwnedAuthorized Agent Signature Date (Revised 9/23/2016) <br />