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� t�uuamg #ysz � <br /> PERMIT APPUCATION I <br /> BUILDING/MECHANICAL/PLUMBING/SIGN / II�IINKLER/ DEMOLITION <br /> CI?Y OF EVERETT PERMIT SERVICES <br /> 320�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 Black lnk Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITf AdDRESS: 9OO W C1SItl0 RD, Everett, WA 98204 PROPERTY TAX#: 0039Z�OOQOO4O� <br /> LEGAL fo�new construction: Short PlaUsubdivision Lot No. (attach copy of lang legal description) <br /> CONTACT INFORMATION <br /> OWNER N�AME: Trailside Preserva#ion LP TENANT NAME(If Commercial): <br /> OWNER MAIUNG ADDRESS: S�E� 21515 Hawthorne BLVD. Suite 390 <br /> Cm Torrance STATE WA z�P 90503 <br /> OWNER PpiONE: 310-802-6682 OWNER EMAIL: Nick Preservation artners.or <br /> coNT�►cTOR NaMe: Holmberg Company <br /> CONTRACTOR ADDRESS: srneer 1128 8th st <br /> �m Kirkland STA,� WA =�P 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EM/UL: <br /> CONTRACTOR LICENSE#{REQUIRED): HOLMBC*OG6ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J100.3 <br /> PRIMARY C4NTACT: �OWNER �CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME: JaCOb KI@I11 CaNTACT PHONE: Q,Z�j-60�..7�]� <br /> CONTACT EMAIL: .lacobK a� halmber co.com <br /> BUILDiNG PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:; 1400 <br /> Pro osed Use of Buildin : Heat Source: ❑Gas OElectric DOther <br /> Buildin T : ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T of Prci ect: ❑New ❑Addition ❑Remodel ORe air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIP7'ION OF WORK: �G�.yp�� �o� �,�(,�.,�,� �N�� �� t�, � ��'o� <br /> Gr�.��, � ° <br /> ASSOCIAI'ED BUILDING PERMiT# if a licable : <br /> MEECHANICAL PERMIT APPLICATION PLUMBING PERMlT APPLICATION <br /> Type of P%�ect: _New _ Addn X Alteration _Repair 7ype of Project: _New _Addn _Altsratton _Repair <br /> #of List of Fixtures #of �st of Ffictur�es #of LTst of Fhrtures #Qf LPst of Fixtmes <br /> Fixtures �ixtures Fixtures Fixtures <br /> A/C—Air Handiin Units Heat Pump 7oilet Backflow Preventer Inside Bidg <br /> Forced Air S tems Unit Heater Bathtub Urinal <br /> Cas Pi in Boiler Lavato ash Basin Drinkin Fountain <br /> Water Heater Refigeration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Dis osal Grease Tra <br /> t�as Ran e Ductin Dishwasher 12oof Drains <br /> (;lothes D er Hooku s Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> E:xhaust Fan Sink Service/BaNMo /etc, Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> (�hemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this applfcaGon and confirm the informatlon contalned hereln Is true and correct.Wak done pursuant to ihis permit must comply with <br /> current/eder�f,state,and local Iew.The granting of a permit only authorizes approved work and no deviations ther+sfiom.Deviatio»s must first 6e authorized in writing from the <br /> Building Ofbcial before being authorized under any circumstance.f am the owner,or!am authorized by the owner of thls property to perform the work for whkh application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of EvereK Ofricial Use Only <br /> ���/+^ PERMI� ��� '� \ <br /> � / U <br /> Owner Autteorized Apent Sipnature Date fRevised 912312016) <br />