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� �unamg #y�� � <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN /= INKLER I DEMOLITIQN <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.gav/permits <br /> {Biue orBlack Ink Oniy Please) PRCiJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 900 W Casino RD, Everett, WA 9$2O� PROPERTY 7AX#: 00392100000401 <br /> LEGAL for new construction: Short PlaUsubdivision Lot Na (attach copy of long legal descripdonj <br /> CONTACT INFORMATION <br /> OWNER NAME: TI'$IISICIB PC@S@N1t1011 LP TENANT NAME(If Commercfal): <br /> OWNER MAIUNG ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance STA7E WA � 90503 <br /> OWNER PHONE: 310-802-6fi82 OWNER EMAIL: NICIt Preservation artners.or <br /> coNTwacroR Nau�E: Holmberg Company <br /> CONTRACTOR ADDRESS: srneEr 1128 8th st <br /> �m Kirkland STA� WA Z� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR UCENSE#(REQUIRED): HOLMBC*OG6ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1 OOS <br /> PRIMARY CONTACT: ❑OWNER �CONTRAGT�R ❑OTHER{Please Speciy) <br /> GONTACT NAME: JaCOb KI@ICI CONTACT PHONE: Q,Qrj..�{)�-7370 <br /> CONTAGT EMAIL: JaCObK�NOII'YtI?@C CO.com <br /> BUILDING PERMIT APPLICATICN <br /> Existin Use of Buildin : Contract PNce of Work:a 1400 <br /> Pro sed Use of Buildin : Heat Source: ❑Gas �Electric ❑�iher <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolitlon ❑Chan e of Use <br /> DESCRIPTION OF WORK: yG�,,,���'� �' o� �i S,}r,„ �„4� �� 1� A..� ���•�(' <br /> Gh�.��� � � o ���.� <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MECI�IANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: _New Addn X AlteratFon _Repair Type of Project: New Addn Altsration _Repair <br /> #of �,fsf of Fixtures #of Ust af�xlures #of Lfst of Ffxturea #of tist of Flxtures <br /> Fixtcires Fixtures fixfures Flxtures <br /> A/C—Air Handlin Units Heat Pump 7oilet Backflow Preverrter Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Unnal <br /> Gas Pi in Boiler Lavato ash Basin Drinki Fountain <br /> V1►ater Heater Refrigeration Shower Floor Drain <br /> Gas Fire lace Wood Stave Kitchen Sink 8�Dis osal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medicat Gas <br /> Ran e Hood Water Heater �ther: <br /> Exhaust Fan Sink(ServiceBaNMo /etc. dther: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed thls epplfcaUon and confrrm the informaUon contained herein!s true and correct.Work done pwsuani to ihis permit must comply wlth <br /> current federal,state,and focal lew. The grenting of a per►nit only auGwrizes approved work and no deviations fherefrom.Deviatlons must first be authorized in writing from the <br /> Building Olfrciaf before being authorized under any circumstance.J am the owner,or!am authorized by ihe owner of thls properfy to pedom+the work for whlch application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Qlficial Use Only <br /> �'" ` �/��? PER�IT# � „OS <br /> ! <br /> OwneNAuthorized As�ent Sipnature Date (Revised 9/23I2016) <br />