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PERMIT APPLICATIOI�- <br /> BUILDIN�CHANICAL/ 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 /> �1ue�o �Jac�C-i�k�0.��: �ie�is�:�� ¢5 ��. ����"�����������i�.�""������ � ���^ �� � ..; <br /> " # <br /> �_� . . _�+�..... .� . .z. _.-�..Y�'._ t .... _ _��, :_ � ...�� .�,..K_ .x _,.� _ �_,_.�, __ ,..�>._ �.,�� <br /> �.. <br /> PROJECT SITE ADDRESS: 9OO W CaSIC10 RD PROPERTY TAX#: 00392�-000-004-0� <br /> LEGAL for new construction: Short PlaUsubdivision Lot Na (attach copy of long legal description) <br /> a'_ ��y � � ":�' �c V,ta' �'. '� >� �a'_�� "_'-� � ���7I� - '-:- �.,:.''k':,,. s a.'i��.x..�v",� �-�a, '�„�.,���_�..�,.,s's .�`� }.�`c�, � <br /> {r�" � te`'' �" . . .�..?" .�:., h.. .•" ..z`«t 'L - Y"`f - <br /> �.� <br /> s �� ���� ������ � � <br /> OWNER NAME: PaCkSIC�e AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�aeer 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STp`TE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOII'T1IJG'f CiO. <br /> CONTRACTOR ADDRESS: s�uEET 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z�JHZZZZ33 CONTRACTOR EMAIL: JaCOIJK@IlOI,CTIb@CgCO.001'Tl <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*OG6ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ��; , ;, � '� {. = ���� .����� :=�l�,R�����VI��' C��1"�TI� ;��� �� �'�� �R.`����`���..�_�, _ <br /> � � �'��1 Tl� � <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: �Commercial ❑Industrial <br /> T pe 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 /> �.�,. ,�"�-�M_EEL�H�\�N1G��►���ERM���A��l����� �".���=��.0�: ��L�MB,11��'a��EE�M���'�' ��+,���z.�' ��� ��� ���, <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of �ist of Fi�ctures #of List of Fixtures #°f List of Fi�ures #°f Lisf of Fixtures <br /> Fixtures Fiactures Fi�ctures Fixtures <br /> A/C—Air Handling Units Heat Pump 4 Toilet Backflow Preven#er(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 /> �SR�ti�IKL"�r31'S�1P��E§S'��`N� �1���-�;" <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and con�rm the information contained herein is true and correet. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only aufhorizes 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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# ,�/ � �`� <br /> ��n <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />