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� �u�ia�ng �ys4 � <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL 1 PLUMBING I SIGN /��INKLER/ DEMQLITlON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> {P)425-257-8810 � FAX 425-257-8857 j(E)everekteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black ink Only Please) PROJECT SITE INFQRMATION <br /> PRWECT SITE ADDRESS: 900 W Casino RD, Everetty WA .9HZO4 PROPERTY TAX#: 00392100000401 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attaeh copy of long legal description) <br /> CONTACT INFf�RMATION <br /> OWNER NAME: TCaIISICIG PC8S81Vr'lflOtl LP TENANT NAME(if Commercfaf): <br /> OWNER MAI�ING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,TM Torrance STA,� WA Z� 90503 <br /> OWNER PMONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNrw►cTOR Na+HE: Holmberg Company <br /> CONTRACTOR ADDRESS: SlREET 1128 8th st <br /> o� Kirkland STA� WA Z� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR�iCENSE#{aEQuiReo�: HOLMBC*OG6ME CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): OS�00.3 <br /> PRIMARY CONTACT: ❑OWNER �CONTRAGTOR ❑OTHER(Please Specify) <br /> CONTAGTNAME: �aCOI� KI@Itl CONTACT PHONE: Q.Zrj-6O2-737Q <br /> coNrncT EM��: JacobK�holmber co.com <br /> BUILDING PERMIT APPLICATION <br /> Exis6n Use of Buildin : Contract Price of Work:S 1400 <br /> Pro osed Use of Buildin : Heat Source: ❑Gas DElec#ric ❑Other <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition ❑Remodel ORe ai� ❑T.I. ❑Si n OS rinkler ODemolition OChan e of Use <br /> DESCRIPTION OF WORK: 4G�„y�,�� ��� �.,�,�.�� �„�� �� l� ,f,..., c���"o�' <br /> O /v.a <br /> Gr���, <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMlT APPLICATION <br /> Type of Project: Naw Addn X Alteration _Repair Type ofi Projeet: Nevr Addn _Alteration _Repalr <br /> #of Lfst of Fixh►res #of �„fst of�xtures #of Llst of Fixtu►es #°f t/st of�ixtu�es <br /> Fixtures Fixfures Flirttrres Flxtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato ash Basin Drinki Fountain <br /> Vlfater Heater Refri eration Shower Floor 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 Other. Clothes Washer Medicai Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/6ar1Mo /etc. Other: <br /> SPRINKLER!�UPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviswed thls applfcaUon and confirm fhe information contalned hereln Js Uve and eorrect.Work done pursuant to this permit must comply wJth <br /> current federal,state,and local lew.The gr�nting of a permit onty authorizes approved work and no deviafions therefrom.Deviallons must flrst be authorized in writing from the <br /> Building O/ficial before being authorized under any circumstance.f am the owner,or 1 am authorized by the owner of th/s property to perform the work for whlch applicafion is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Ciry of Eve�ett Off'icial Use Only <br /> PERMIT <br /> �/►��� N�. O O <br /> er/Authorized Apent Sipnature Date (Revised 9/23/2016) <br />