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PERMIT APPUCATIOI� <br /> BUILDINOECHANICAL/ PLUMBING /SIGN�� �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 /> ���ie.�+��-B,����c �►,���r '�ase��- �� fi.� �-$���� .������. �. �� '� �<n�� F=� `� � �� �. <br /> PROJECT SITE ADDRESS; 9OO W CaSIC10 RD � PROPERTY TAX#: 0039Z1-OOO-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> a n`�y x a:, t:r .�C � +,; ,. � y�y� � /► �.�.,�`•�: "^ ■ ",�' -,a�*�.. �" '� >. �+r t ��y� ;.�n�.� �. '�"�e .,�.� r;a . <br /> P - ' � � :;,�:-, :YV���V���7����. ��l_�� �`c-._ �� �..Y��< �s. i. -�� <br /> OWNER NAME: PaPkSICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�eeT 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII1l�J@f CO. <br /> CONTRACTOR ADDRESS: STREET 1128 8th St E <br /> ��r Kirkland STA� WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Zrj$ZZZZ$$ CONTRACTOR EMAIL: JICOIJK@Il0IfT1IJ2CgCO.00171 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERE7T BUSINESS LICENSE#(REQUIRED): OrJi 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> � : � � � � ; � . { � � � <br /> �. :;�.r, ��,:... � : �.�.�, r.. zs�<., _.,. �:., ..,� �.�.����1.�,. .�� !►�'lA.1�1.� �, �:�� ,x ��-�,n �_���, �'� �:� >,� <br /> U1I.A1, :��-�!C � <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑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 /> ;.��`..�`�NEt31�AN'���►��-��LNII�'A`P=P..L�C�1'�'�ON� , �`: ', _ '- ���'��,�' �1111 ,N��'�R�NI�T�PP�.�C�A.7°�IDI!��'-`� _���"�`��,-� <br /> ,-� s� � <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of ��st of Fixtures #of ��st of Fixtures #of List of Fixtures #°f List of Fixfures <br /> Fixtures 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 [� 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/BaNMop/etc.) Other: <br /> ;` �. „�PR�N:M(�.'�t�`a��P�;R�S�tbN��SYSTwE�I'll� ��� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and con�rm the information contained herein is frue and correct. Work done pursuant to this permit must comp/y with <br /> current federal,state,and/ocal 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�cia/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 Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Everett O�cial Use Only <br /> PERMIT# ���on� <br /> /J <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />