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��� <br /> PERMIT APPLICATMON <br /> BUlLDING/MECHANICAL/PLUMBING 1 SICaN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> {P)425-257-8810 ( FAX 425-257-885? f(E}everetteps(o�everetlwa.gov E www.everettwa.govlperrnfts <br /> (Blu�or Black Ink Onl Please PROJECT SITE 1NFORMATION ' <br /> PROJECT SITE ADDRES3: W C�Sitl(7 RC? PROPERTY TAX�: OO$�Z'I-�OQ-OO4-01 <br /> LEGAL for new constructfon: 5hort Plat/subdivEsion Lot No. (attach capy af lanp Isgal descriptton) <br /> CONTACT 1NFORMATION <br /> OWNER NANNE: Parkside Ac uisi#ion Preservatian TENANT NAME 1(Canmarcfal): <br /> OWNER MAILIN6 ADDRESS: ��T 21515 Hawthorne BLVD STE 395 <br /> �m Torrance STA,� GA aP 9U503 <br /> OWNER PFIONE: OWNER EMAIL: <br /> con�wacroR�e: Halmber Co, <br /> CONTRACTOR ADDRES�&: s�r ��Z� $t�1 St E <br /> cm Kit'kl�tld sr�� WA zw 9$Q33 <br /> coivraacto�t p�oN�: 4258222233 CONTRACTOR EMAIL: �IacobK�a halmber co.com <br /> CQtVTRACTOR LICENSE�(REQUIRE�): I�OLMBC"`066ME CITY OF EVERETTBU81NES81.ICENSEI�(REQUERED): ��j��� <br /> PRIMARY CONTACT: C1 dWNER �CONTRACTOR ❑07HER(Piease Specity) <br /> CONTACT NAIAE: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ... . .: : : . .. .. .. : .... . , ., .. . .: <br /> , .. . .. .. .... ..... ...... <br /> ., BUILDINti PERMIT APPLICATION . � <br /> Existin Use of Buildi : Cot�trect FMce of Work:i <br /> P osed Use of BuAdin : Heat Source: �Gas OE1ecVEc �ather <br /> Buildin T ; OSFlt-Detached ❑SFR-Attached I�Du lex �MuItFFamil -#of Units: �Commerdal �Industriat <br /> T of Pro ect: �New �ditEon �Remodei ❑Re ir �IT.i. �Si n �S rinkler I�Derrrolition OChan e of Use <br /> DESCRIPTlON OF WORK: Replacing Twa Toilets and Lavatorfes <br /> �� ��g - oscl <br /> AS$OCIATED BUILDINf3 PERMIT# if a iicable: <br /> MECHANICAL PERMIT APPLICATION PLUMBINO.PERMIT APPI.ECATION � � <br /> Type of ProJeet TNew ,_, Addn �4ltaratlon Rspdr Typs of Pro)eet: �Nwr ,�Wdn _Albratl� „Repah <br /> Flxtures �+at oiFfxturoa �� tlst ot f!x(ures � Ust o1 Flxw�sa � L4t of Fb�turas <br /> A/C--Air Handlln Units Heat Pum 2 Toilet Bsckflow Preventer fnside Bld <br /> Forced Air tems Unit Heater Bathiub Urfnal <br /> Gas Pi In Boller 2 Lavat ash Basin Drinkln Fountain <br /> Water Heat� Refri eration Shower Floor Drain <br /> �as Fireplace Wood Stove Kitchen Sink&D sal Grease Trap <br /> Gas Ran Ductin Dfshwash� Roaf Drains <br /> Clotfies D Hoaku s (7��: Clothes Washer M�icai Gas <br /> Ran Hood Water Heater (3ther. <br /> Exhaust Fan 5ink ServiCe/Bar/Mo etc. ather: <br /> SPRfNKLER/3RUPPRESSiON ltY3TEM <br /> Chemical or Water No.at 1leads <br /> ACKNpWLEDGEME'NT.•!hav�e mvlewed lhls appAcaUon and coM)rtn fha lnlo►met►on contalned hereln is tnre and conect Work done parsuent to thla pam�ft must comply wtth <br /> aumsnt federal,atete,and foce!Jaw.The graMfng of e pemJt on y autho�zas epproved w�nrk and no devfetbns therefinm.bevfatlw►a must ftrst be authorfzsd fn w�ilfnp Irom the <br /> 8uddhr{�OAScls!befora being euthnrJzed under any cfrcwnatence.!em the owner,o�l am euthaiud 6y the owaar of this prope�y to perform ths wvrk for whlch app!lcetMrt fs rt�ede, <br /> end!comply wlth the Stete Centrectws Lew f 8.27 RCW afwf 796.200A WAG. <br /> C!ty of Everett OA4de1 USB�nly <br /> �/ C��,�� � PERMir �� J d� <br /> , <br /> OwnerfAuthor(rsd IAyent 8lynaturo Date {Revlsed 9/23/20f6) <br />