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CI <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (13)425-267-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govipermits <br /> (Blue or Black Ink Only Please)99 <br /> (D PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,9JW 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: sTRE r 21515 Hawthorne BLVD STE 395 <br /> • <br /> an, Torrance STATE CA ZIP 90503 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Holmberg Co. <br /> CONTRACTOR ADDRESS: STREET 1 128 8th St E <br /> any 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#(REQtiIRED): 051003 <br /> PRIMARY CONTACT: Cl 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:$ `tLICZO <br /> Proposed Use of Building: Heat Source: CIGas DElectric DOther <br /> Building Type: DSFR-Detached C ISFR-Attached ©Duplex DMuiti-Family-#of Units: I71Commercial C]Industrial <br /> Type of Project: Mew DAddition ®Remodel DRepalr CIT.I. DSign OSprinkier ODemolition C/Change of Use <br /> DESCRIPTION OF WORK: Replacing Two Toilets and Lavatories and Two <br /> Showers Ce o — OCo n <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 /> #of List of Fixtures #of List of Fixtures #of List of Fixtures of List of Fbrtu ea <br /> Fixtures Fixtures Futures FBrhuea <br /> NC Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater W 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/SUPPRESSION SYSTEM <br /> !Chemical or Water J JNo.of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this eippicatlan and confirm the Information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,end local law.Me granting of a permit any authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or!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 288.200A WAC. <br /> CityofEvverett Official Use Only <br /> 7;r3. t PER <br /> t v w O <br /> Own Authorized Agent gnature Date (Revised 3/2016) <br />