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I building #980 I <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL I PLUMBING /SIGN /il1NKLER I DEMOLITION <br /> #.4Pa:PF--"4 <br /> 11 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 900 W Casino RD, Everett, WA 98204 PROPERTY TAX#: 00392100000401 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Trailside Preservation LP TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 21515 Hawthorne BLVD. Suite 390 <br /> CRY Torrance STATE WA ZIP 90503 <br /> OWNER PHONE: 310-802-6682 OWNER EMAIL: Nick@Preservationpartners.org <br /> CONTRACTOR NAME: Holmberg Company <br /> CONTRACTOR ADDRESS: STREET 1128 8th St <br /> CITY Kirkland STATE WA ZIP 98033 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): HOLMBC*066ME CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 051003 <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT PHONE: 425-602-7370 <br /> CONTACT NAME: Jacob Klein <br /> CONTACT EMAIL: JacobK@holmbergco.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1400 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric El Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: CI Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: -04L v � J� o� (S � \ A~ � 1,-,43.AS. 4AD �•o� <br /> Gh�.�P/j, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn X Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #ofList of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–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 L 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/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,or I am authorized by the owner of this properly 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 /> ji / -D /2/i 7 PER <br /> \,..3c03 — 059 <br /> Owner/Authorized Aaent Signature Date (Revised 9/23/2016) <br />