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PERMIT APPLICATION- <br /> 0010111PBUILDIN_CHANICAL/ PLUMBING /SIGN mRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> wr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> LO a rA6I,_ n ° R40.- #4.: '' i0J TSI ` IIi1F �(MI1 ;t ;;A; .:: ° y r.._, <br /> PROJECT SITE ADDRESS: 900 W Casino RD cm PROPERTY TAX#: 003921-000-004-01 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �,'i'."��mtr f'"� ;' x� + 4'�'`-�. ,�s, w�.w �a.F.a::�?.4��S.- M ..;,,.r.:.x �`„° a� �r�� 3.€ H.r�^', `�` s ,'cat.,;,r:::�� "� r.,;. <br /> -�-. . _, � ,ate �;�. �- : ��.� � xa� _,.,m. ...�... ,..,,.w '; .. :v ;' u,:. .�„.,� r,�4�<.,:�'.o��:_:?; k�,:r_.�.C�`�`n'`..:..�a.x..ks?�+�t+,.,:;��.2?... `;�'s <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 /> Cir 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 121 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> :; gF OIL 1NG jPERMI *CltA ri0*R- ., -.;- ...t ._r. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric DOther _ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ®Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ®Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler El 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): �y i <br /> . <br /> `Y k ..:,010# �w ,i� a 'y 0 att tftgPL MBi . ,x..2-Et.�it,E,:d .' :::;Ntwox <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump - 4' Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 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 I 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.I am the owner,or I 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 /> PERMIT# <br /> d Irl.0? -020 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />