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PERMIT APPLICATION <br /> 100)./011?=.1 BUILDING ECHANICAL/PLUMBING /SIGN / 2INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> l —■3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> -rte.= <br /> 41 c Ir1k .l! < 4 r . , ..z 090 _ i* ,m . r ,n` <br /> Ly � <br /> fil <br /> PROJECT SITE ADDRESS: 900 W Casino RD f 3 j PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: Parkside Acquisition Preservation TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 21515 Hawthorne BLVD STE 395 <br /> CITY Torrance STATE CA ZIP 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Holmberg Co. <br /> CONTRACTOR ADDRESS: STREET 1128 8th St E <br /> CITY Kirkland STATE WA ZiP 98033 <br /> CONTRACTOR PHONE: 4258222233 CONTRACTOR EMAIL: JacobK@holmbergco.com <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 051 003 <br /> PRIMARY CONTACT: 0 OWNER D CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> k 3. :.MS."_Ai m 4�"��` tt k WtOfti„OWR111 t* _ . . VMINMSS, I.^''t .... } ..g>'"l_ . t,r `h i"sI <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 BUILDING PERMIT#(if applicable): <br /> ' 5 t '� .3L10A000 ,. `W . _ y x ) G ER`Nll ° \' . 4014 0.*1-M " NA <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump a Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler a 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/Bar/Mop/etc.) Other: <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,or 1 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 Everett Official Use Only <br /> PERMAIT�# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />