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PERMIT APPLICATIOI� <br /> BUILDINaECHANICAL/ 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 /> ���N;/����t���S�R� �S�k��-�"�'�e`ti�����Y�� ������ „� ��� R��?' �.4`ri.f� xn f��.. ��s`'�� �s��„�.��i <br /> �.w'uz . .... $ ✓, . <br /> � <br /> PROJECT SITE ADDRESS: 9OO W CciSl110 RD PROPERTY TAX#: 00392�-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot o. (attach copy of long legal description) <br /> ... � ��� „� �-� : � �,- x�. ?�►C � .�,��- �,� : ��-�� � ��� <br /> � x <br /> �_�..�.����..� .;� _. ���� , � F ��k��z�,... ��ON �� f�,�i�1�►���� <� �-�� :�� �``.���� ' <br /> , <br /> � <br /> OWNER NAME: Parkside Ac uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srneer 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOICTII�@f CO. <br /> CONTRACTOR ADDRESS: sraEET 1128 8th St E <br /> ��n Kirkland STA,� WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJH2Z2233 CONTRACTOR EMAIL: .JaCOIJKQt I10ICYlb@CgCO.00111 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*O66M E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OrJ1 003 <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> :'. {� .' .Y�sv F �3 ' ",� ; . � ■. /�_p�+' k �r r� ",� t= ; .;., r �. �" t .. 7 .� s ,. � � <br /> k..�i v"'�"�'a''` �,3'�'��rx . L' L-'�>a En. -- ...: :;+-, �' ��IL�IN�7���,E1�'��!.�.��.�iM�� ..-��*�'_�,.'l`..5t�,-,.r�::�..'x,"n�, '` '€✓'M �' '"�",�� 's........, :.sY::TtE�� <br /> � 1 <br /> .'u a`:�,'`ti. ,i,�x[e ,..1„"��:i3'..'a,9, ..�,+.,�-o- <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 /> Type 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 /> _ <br /> G,:: . �(11E���1�1'�-�.E��I111��PPLIC��1'���1����: ; ., � �'�`���� � BI,�1�� MI�`�A�PL'�����i��l � x�"..�� s <br /> �,��;�-�� �� <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fi�rtures #of List of Fixtures #°f List of Fixtures #of List of Fixfures <br /> Fixtures Fixtures Fi�rtures Fixfures <br /> A/C—Air Handling Units Heat Pump 4 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 D er Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan t� Sink(Service/Bar/Mop/etc.) Other: <br /> �y �`�.� �„��.�������ss��N��r���ni�x � <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 comply with <br /> current federal,stafe,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cia/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 1 comp/y with fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# � o ���� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />