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PERMIT APPLICATIOI'� � <br /> BUILDINC�ECHANICAL/ PLUMBING /SIGN I �INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98204 <br /> {P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> ������o.r�lack�nk�,ia�.�/�'��a����� ��� .,���E i�'���.1a1����N1#1�Q7�,����,����,`���.� �-�� ��- _ <br /> �:� <br /> PROJECT SITE ADDRESS: 9OO W CaSltlO RD -6 PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Shoft PlaUsubdivision Lot No. (attach copy oflong legal description) <br /> � - r�-=, k � � - � �flN3'A���1�f0�11���310�1 �,� ' � � �� � �'���..:.x>� <br /> OWNER NAME: Pal'kSIC�G' AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOICTIIJ@I' CO. <br /> CONTRACTOR ADDRESS: sTReET 1128 8th St E <br /> ��n Kirkland STA� WA Z�P 98033 <br /> CONTRACTOR PHONE: 42'rJ$22ZZ3S CONTRACTOR EMAIL: JaCOIJK@Il0IC1'lIJ@CgCO.COIII <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OJ1 003 <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> �.,.��,."`-,�..,'���*X:y s �..��� ��� i .;�"������1�V� _ .�,� ���µ� ��.����.*,:.�..��'� .���,� ��' wx-.����_��SKx����:�'. <br /> Existing Use of Building: Contract Price of Work:$ <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 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 ap licable : <br /> �: F�=� ����►�i���.��nn,�ar��►���..���r�'����, � �� �-���������r,��,���ni����.���;��►:�`����� ;,���..� <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of ��st of Fixtures #of List of Fixfures #of ��st of Fixtures #of Lisf of Fixfures <br /> Fixfures Fixtures Fixtures Fixfures <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 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 4 Sink(Service/Bar/Mop/etc.) Other: <br /> �£'���S���NK��R�!�$�PPRES�S�,;�N���'.f���'�`.:.Y <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the informafion contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,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 Official before being authorized under any circumstance.1 am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply wifh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> PERMIT# � �� D�� O�� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />