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� r�una�ng �y i� � <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING/SIGN /�INKLER/ DEMOLITION <br /> CI7Y 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 /> (Blue or Blaek Ink Only Pieasej PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 9OO W CaSltlO RD, Everett, wl4 982�4 PROPERTY TAX#: OOS92�O000040'I <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. {attach copy of Iqng legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preservation LP TENANT NAME{if Commercfal): <br /> OWNER MAILING ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> �,� Torrance STA,� WA Z� 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNTwe►cTOR Nan��: Holmberg Company <br /> CONTRACTOR ADDRESS: sTa�T 1128 8th st <br /> �m Kirkland STA� WA Z� 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CON7RACTOR LICENSE#{REQUIRED): HOLMBC*066M E cmr oF��r Busi�ess uceNse��aui�o�: 051003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: JaCOI� KI6111 GONTACT PHONE: 425-6p2-7370 <br /> CONTACT EMAIL: JaCOI�K�IIOIIIIb@i' CO.com <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:S 1400 <br /> Pro sed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑�ther <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T of Pro'ect: ❑New ❑Addition �Remodel ORe air ❑T.I. ❑Si n OS rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: yL�,o�� ��� ��5,�,�� �M 4� �� 1� ,I.,., ���"o� <br /> Gh�'�P�j, v o iv�� <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPlICAT10N <br /> Type of Project: New Addn X Alteration ,_ltepair Type of Project: _New Addn _Alteration _Repair <br /> #of tist of Fi�ctures #°f tfst of�xtures #of LFst af Ff�ures �°f List of Fixtures <br /> Finfures Fi�ctures Fixtures F/xtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow FreveMer Inside Bld <br /> Forced Air S tems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Refri eratian Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Dis osal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEOGFMEN7:•f have reviewed thls applfcation and conrtrm the informaUon contalned herein Js Uue artd conect.Work done pu�suant fo fhis permit must comply with <br /> cu�rent federal,state,and locaJ law.The granting of a permit only authorizes approved work and no deviations ther+efmm.DevlatTons must llrst 6e euthorized in writing fiom the <br /> Building Official beiore being authorized ur�der any circumstance.1 am the owner,or!am authorized by ihe ovrmer of thls property to perform the work for whlch application is made, <br /> and l comply with the 3tate Coniractors Law 18.27 RCW and 296.200A WAC. <br /> Cky of Everett Off'iciat I/se Only <br /> �1.�� �/ / �^-� PER V ' 1, \�� � O� � <br /> 7 � <br /> Owner/Authorized A�aent Sipnature Date lRevised 9l23/2016) <br />