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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 /> ���+���,���cx����,��r��eas�e������� - ���,.��'�s��� ���►����.� �, � �=� �� 4:�� <br /> �.x <br /> PROJECT SITE ADDRESS: 9OO W CaS1110 RD � PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �.�`��,,.,�*y .: ,..�:, ��...� ,.:�.. �, �,.. :' � � ;C�N`���"�'��1F,Q�ll�l�l'�alaAN � <:�5� ��� � �.r������..�:�� �'�`�`��,���� `�f: <br /> � <br /> OWNER NAME: P11'kSICI@ AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTaeer 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIfT1IJeC CO. <br /> CONTRACTOR ADDRESS: S7REET 1128 8th St E <br /> ��n Kirkland STA� WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJH2ZZZ3S CONTRACTOR EMAIL: JaCOIJK@Il0If1'1b2CgCO.COIII <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC�O6GME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OJ1 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> f �� �4 - ��i1��.� .�.��R`�i11T°�►��PL�C��IflN - -�: � ����.�f��.�������°_-.�.� <br /> : � � <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 ❑Du lex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> Type 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 /> ��� b�'�VIECNAI�IIG�1L"��RIIAIT;�!l,��NL���#��1�31+1:�. M�.��M ���;µ�-�'L.�IM�ING��RRlV11T 'P� �;n.:_ ������:�,.� <br /> v.,�.. .h �,_. . � , �a�° N :c,�x � a ,.. ,,,�r.. �, �,� <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of ��st of Fixtures #°f List of Fixtures #of ��st of Fixtures #of List of Fixtures <br /> Fintures Fixfures Fiufures 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 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 t� Sink(Service/Bar/Mop/etc.) Other: <br /> a ��`�`��PR�NICL�R I`SIiPPR�S�SIa��S�,S �M�:� �' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comp/y with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations muSt�rst be authorized in writing from the <br /> Building Official before being aufhorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT I�� n _ ��� <br /> V� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />