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PERMIT APPLICATIOI�I <br /> BUILDINC�IECHANICAL/ PLUMBING /SIGN � �RINKLER/ DEMOLITtON <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 /> $l�!+e�� ,r���,��.�.�l�/�"� .���:��`��.;`���p,�„���'���E�1���D�R1VI���N - °::� �-� -�:� �� �,.� <br /> =1� . , � v,., ;�, <br /> ,�. <br /> o. .�.m ,�.r.z�� _ ,...,. ..__, �� . �� <br /> PROJECT SITE ADDRESS: 9OO W CaS1110 RD a a PROPERTY TAX#: 0039Z 1-000-004-0'I <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> i'*'-,;,� "t� . �� �' sYk" � �v 4`'�: 'zs" � -�"'�3 � �-:k- -ir�s.v�`-�"a-`` .' ,.�'�' �� �,.�. ",� ""�. �,E: <br /> �,�.,�.. .���,��.� ������� �- .�� 3 �Cfl,i�TA��'� I�P#�R�111�►����1��.�.��� _��,��,`�;�,-���.,���� � <br /> ��. <br /> OWNER NAME: PaCkSIC�G' AC UISItIOtI Pt'2S@CVatIOCI TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sixEer 21515 Hawthorne BLVD STE 395 <br /> �� Torrance STA� CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIt11I�@C CiO. <br /> CONTRACTOR ADDRESS: snze� 1128 8th St E <br /> �� Kirkland STA-� WA z�P 98033 <br /> CONTRACTOR PHONE: 4Z'JrH2ZZZ3S CONTRACTOR EMAIL: JaCOIJK@IlOIt1lI�@CgC0.00111 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC�`066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> � .� �' ,� $, �� ���:. :��3.�.���i�7NG`�nPE#t�1111�rt��`PF�..1��0��1������"������r_.�'��'¢ �., �` ��K ` $ <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Ty e: ❑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 a licable : <br /> ' ��YIE�C��►`+11����� 1T�'��KP,�.�I�fA��t��l �� ��' � �..-�� �r�,�� ��.L�lIi�B�.�����I�' "�� ��1���1�����,.�.���. <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of �ist of Fixtures #of List of Fixtures #of ��st of Fixtures #of List of Fixtures <br /> Fixtures Fixfures 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 C� Sink(Service/Bar/Mop/etc.) Other: <br /> � �:�P.�tI�I�C�.�g��.�.�'. . �����f�-�Nl:� <br /> Y»,,z,. �� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comp/y with <br /> cu�rent federal,state,and/ocal law.The gianting of a permit on/y 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 1 am authorized by the owner of this property to perform the work for which app/ication is made, <br /> and 1 comply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> PERMIT# � � /� _ �`e� <br /> �is � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />