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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING 1 SIGN I SPRINKLER 1 DEMOLITION <br /> "IP1416./%;----4 <br /> _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsGeverettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: VIr W Casino RD PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new constructlon: �'! -'�: ivIs#on 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 /> ami Torrance STATE CA zp 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Holmberg Co. <br /> CONTRACTOR ADDRESS: sTREEr 1128 8th St E <br /> cin Kirkland STATE WA zap 98033 <br /> CONTRACTOR PHONE: 4258222233 1CONTRACTOR EMAIL: JacobK c@. holmbergco.com <br /> CONTRACTOR LICENSE#(REQUIRED): HOLM BC*066M E ICITY OF EVERErr BUSINESS LICENSE#(REQUIRED): 051003 <br /> PRIMARY CONTACT: D OWNER ®CONTRACTOR 0 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: DGas DElectric DOther_qa-CO <br /> Building Type: DSFR-Detached DSFR Attached °Duplex DMulti-Family#of Units: ®Commercial 0Industrial <br /> Type of Project CINew °Addition ®Remodel °Repair DT.I. DSign °Sprinkler DDemolition °Change of Use <br /> DESCRIPTION OF WORK: Replacing Two Toilets and Lavatories and Two <br /> Showers <br /> SIU•©IS _ �3(40 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION . PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn Ateration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of F/shnos l�xtu>as List of Fixtures List of fixtures F Sia List of Fixtures <br /> FixturesA/C—Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 2 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 2 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 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> 'Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application end confmr the lnfo►mstlon contained herein Is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state end local law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized M witting from the <br /> Building Official before being authorized underany circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7D°37!---) P _ off <br /> 3 <br /> Owner/Authorized Agent gnature Date (Revised 9/23/2016) <br />