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PERMIT APPLICATIO��. <br /> BUILDINaECHANICAL/ PLUMBING /SIGN I' �'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� wvuw.everettwa.gov/permits <br /> 8 i� 1�,_�. :�!'! , @�"`se' �' � £ �' ,�t�`0����� '1�1�' 1� � �,� �r-;� _�� <br /> �.�� <br /> �,�� .�5.��� ,��� ������ �� :.�� ����� `'���. � W <br /> PROJECT SITE ADDRESS: 9OO W CaS1110 RD � / PROPERTY TAX#: OOS9Z'I-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> `?.�¢i� .�r+ �rra -�� x �� .. . ti tr 3" n„'�e: "3,z�,..sY>t .:: -"s '�' x: ,� s•�a`.3.�'�'�F o-s k ..a� v �z <br /> ����.�s��Y-�k�.��...��� �`�s`�, � '; � ` �:'," � `= ;,���'�1G'1'��lf��#�I '��'���a„ �,� �� � �, �,���= <br /> ,..�. � � br,..�. �,. _.�.���. <br /> OWNER NAME: PaCI(SICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: SIREET 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIR1I�2f CO. <br /> CONTRACTOR ADDRESS: s-rReer 1128 8th St E <br /> �m Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJS2Z2L33 CONTRACTOR EMAIL: Jc'iCOIJK�U Il0If11IJG'PgCO.COfT1 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*O66ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OGJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ��,�:�_.���.�`�r.�'�'s�.. :s=c �;. ,�:r�. s)��:, � ��AL"�����..�ryl� �... �������-�� nr �' :�u ��, �. a �:'�i.4�c,.�Y .�����,> <br /> s�� .z� �a '�r ;�; �r�. �- �-.� <br /> Existing Use of Building: Contract Price of Work:$ <br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> T pe of Pro'ect: ❑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 /> . <br /> k�� _,. ���1��'I.�.��IAlT;��PL A?i �` ��� �`"`��N q 1: 8��1��P.fRM13'� �i0��� ,��� ` - <br /> .�...,, ,�.� .�. . < J�,�.� !������ .� ���� .� .�_ <br /> _ � ,�� _ _.�'��� `�...�..��.�� .�. <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of ��st of Fixtures #of �ist of Fixtures #of ��st of Fintures #of ��st of Fixtures <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 q(� 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 /> Ran e Hood Water Heater Other: <br /> Exhaust Fan t� Sink(Service/BadMop/etc.) Other: <br /> s� �:k'...b � ������Y�������.IYI�,�}7�����ie'`l 3�A'� <br /> t� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confrrm the information contained herein is true and cor�ect.Work done pursuant to this permit must comp/y with <br /> current federal,sfate,and/ocal law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing fiom the <br /> Building O�cial before being authorized under any circumstance.I am the owne�or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> � PERMIT# <br /> D � ��3-���,� <br /> OwneNAuthorized Agent Signature Date (Revised 9/23/201 )- <br />