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I Building #992 I <br /> /41 <br /> III' PERMIT APPLICATION <br /> ` BUILDING/MECHANICALI PLUMBING /SIGN / 'WINKLER/ DEMOLITION <br /> �--A 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 PlaVsubdivision 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 /> crry 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 /> cm 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: 0 OWNER ®CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Jacob Klein CONTACT PHONE: 425-602-7370 <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: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 13 Industrial <br /> Type of Project: ❑New ❑-046.k,..1„:4-v.... <br /> Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I��,G p�� �m eC,--,.r,_„ 6,..&,,,, �� lO ,f 1V`..� ar <br /> A-,,-,- .� , ......N <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 /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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 Li Wood Stove _Kitchen Sink 8,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/SUPPRESSION SYSTEM _ <br /> Chemical or Water I INo.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 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 <br /> (of Everett Official Use Only <br /> ' " ' <br /> 77717 PERMIT i ,� n \� —D co r Vr <br /> 'Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />