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PERMIT APPLICATIOI� <br /> BUILDIN�ECHANICAL/ PLUMBING /SIGN ' �21NKLER/ 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 /> ��i+ue`or�Bl���C�n����'.�..e�st��n�- ������EC��1���N�RN1���� �.���������-�-�.F��� ����z.��E` <br /> PROJECT SITE ADDRESS: 9OO W CaSltlO RD PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> E�,�" x... -z� �. `y ,. � ,..�..y a�"��t� `"_ '>stt `��4'�" t r� k y»� <br /> � � ��� az.}� �o�r�►��ar�Fo��n�►Ta��� � .�. ��. -� �_ ,k._ � � <br /> OWNER NAME: PaCECSICIe AC uisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�aeeT 21515 Hawthorne BLVD STE 395 <br /> ��TM Torrance STATE CA Z�P 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: HOIfTII�@f �:0. <br /> CONTRACTOR ADDRESS: srReer 1128 8th St E <br /> ��n Kirkland STATE WA Z�P 98033 <br /> CONTRACTOR PHONE: 4Z'rJHZZZ233 CONTRACTOR EMAIL: JaCOI�KQG IIOICTII�G'fgC0.00111 <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�J1-003 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> � x , "_`, .:�;� , � "�wk:, a�x. �� `BUIL�ING�PE1� ��'��..�,�P�� ��' ' ���<:w�`�`�`��, �.�����'��"�t�,.x; <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 BUILbING PERMIT# if applicable: <br /> F�-` ���ui" ��� � �� �1�,A�P�C���1!�,N;��. w; � n� �,�� y� �.��s�����i�n���ci�,,.��ic�►T-��N �-��� _��°_ <br /> .i�� ��►__ .�- <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixfures Fixtures Fixtures <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 Q. ' 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 t�. Sink($ervice/Bar/Mop/etc. Other. <br /> '� �"�P�3�1�1l�:�'„1��� P��3 S �N��R'�E�IIv <br /> � _�.� �. �_ °� <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 comp/y with <br /> current federal,stafe,and/ocal 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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# � � �:y 0 <br /> ��,r; <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />