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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermlts <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 900 W Casino RD PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Parkside Acquisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 21515 Hawthorne BLVD STE 395 <br /> Curr Torrance STATE CA ZIP 90503 <br /> OWNER PHONE: IOWNER EMAIL: <br /> CONTRACTOR NAME: Holmberg Co. <br /> CONTRACTOR ADDRESS: srmsr 1128 8th St E <br /> CRY Kirkland STATE WA zip 98033 <br /> CONTRACTOR PHONE 4258222233 CONTRACTOR EMAIL: JacobK@holmbergco.com <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME ICITYOFEVERETT BUSINESS LICENSE t QUIRED): 051003 <br /> PRIMARY CONTACT: D OWNER °CONTRACTOR °OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> • BUILDING PERMIT APPLICATION • <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: °Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ®Commercial ❑Industrial <br /> Type of Project Mew ❑Addition MiRemodel ❑Repair OT.I. °Sign ❑Sprinkler ©Demolition ©Change of Use <br /> DESCRIPTION OF WORK: <br /> Replacing Two Water Heaters <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • MECHANICAL PERMIT APPLICATION • PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration_Repair Type of Project: New Addn ;,,,_,Alteration _Repair <br /> tR ofList of Fixtures of List of Fixtures Sof List ofnatures #of List of Futures <br /> Fixtures Futures Futures Fixtures <br /> NC—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 Darer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 2 Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc) Other <br /> SPRINKLER I SUPPRESSION SYSTEM <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 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.lam the owner,ori em authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Conbectors Law 18.27 RCW and 298.200A WAC. <br /> / t. City� of Everett Official Use Only <br /> a—) i/ ` PERMIT# 17 0 - i <br /> Owner/Authorizedent Signature g nature <br /> Date (Revised 9/23/201 <br />