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PERMIT APPLICATIO� <br /> BUILDINahECHANICAL/ 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 /> �3#�re�ur;�,Bia�k��Nc;������ ������� �-,�����������.4����l��III�,�I'�I�N-��-- � ���. �`,� ' �;� .w�i.� � <br /> PROJECT SITE ADDRESS: 9OO W G'c1SIf10 RD PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �.x.,a �4�,; ,' .,���:� � � .�v=��CO�!IT�CT�NF�RNI�I�J�ON�..<_, ��-�:���z���,.,.��",���:�� � � .z.�... � n�` <br /> �� <br /> OWNER NAME: PaCkSICI2 AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREEr 21515 Hawthorne BLVD STE 395 <br /> ��n Torrance STA,� CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOICYlIJ2C �'i0. <br /> CONTRACTOR ADDRESS: srnEeT 1128 8th St E <br /> ��n Kirkland STA,� WA z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJHZZZ23S CONTRACTOR EMAIL: �c1C0I�K@IIOIfI'lI�@CgCO.COCII <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*OG6ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O'rJi 003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ` �. -� .�"�, �#�1�.D �C�ERM1��►�',�'�-�CA�'��O�i�l �'`'�-�5�� ����. > � � e <br /> -� _} ,�. .;F�� ,�� �;,,�,.�.�_ ��,_ ��. m-��;�,��� «��'���.. ��'; ..��, M.�n � <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Si n ❑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 a plicable : <br /> s'=f ,,��MEC#�1�N1�g1����1 � �1���1,��i W z���' ;',,� ,��:,�;�PI.�M.B���'a�'���jt3`���..`�,����I;���"�07!� � �� ;�,,:.�-...�: <br /> .. � <br /> ..xw. _ AW . ,__ . .�.. � . �;;` �_ .a � . . _ � <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn Alteration _Reqair <br /> #of ��st of Fixtures #�f List of Fixtures #of List of Fixfures #of Lisf of Fixtures <br /> Fi�rtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer Inside Bld ) <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 Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan 4 Sink(Service/BadMop/etc.) Other: <br /> �`�PRINrC�:ERI�����;R����N��C�NL�..� �� <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comp/y 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 O�cial before being authorized under any circumstance.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everetf O�cia/U Only <br /> PERMIT# � o � � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />