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PERMIT APPLICATIC
<br /> BUILDIIIECHANICAL/ PLUMBING /SIGI—WRINKLER/ DEMOLITION
<br /> d":"tb411.1111°
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 411‘713200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS:1 OO9 112th st SW, everett wa 9820: PROPERTY TAX#:01003100330300
<br /> LEGAL for new construction: Short Plat/subdivision Camlyn Condominium Lo ' .. (attach copy of long legal description)
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<br /> OWNER NAME: Jura Stirbys TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1115 North 140th st
<br /> crry Seattle STATE wa ZIP 98133
<br /> OWNER PHONE:206.455.0411 OWNER EMAIL:jStirbys@mCIeOdCOtlstr'UCtiOrl.COfil
<br /> CONTRACTOR NAME:McLeod Construction LLC
<br /> CONTRACTOR ADDRESS: STREET 1115 N 140th St
<br /> cnv Seattle STATE WA 2IP 98133
<br /> CONTRACTOR PHONE:206.545.7837 CONTRACTOR EMAIL:jStirbys@nlcleodconstruction.com
<br /> CONTRACTOR LICENSE#(REQUIRED):MCLEOCL951 DD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 043502
<br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:206.455.0411
<br /> J Ura Stirbys CONTACT EMAIL:jstirbys@mcleodconstruction.com
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<br /> Existing Use of Building:143 Single family residence condo Contract Price of Work:$• 2.-)of)60
<br /> Proposed Use of Building: no change Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR LITownhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑✓Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Rebuild damaged carport
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> 1113#041:4010:0104,010104100,00V4 Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System 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,a . --- - .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.1 .re being authon -d 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 c mpl 'ith the State Contra : aw 18. R�CW and 296.200A WAC.
<br /> I(Ap City of Everett Official Use Only
<br /> e 011.4‘( PERM
<br /> .-4111111111K=$.
<br /> Owner/Authorized ' •.������ Date (Revised 10/10/2018)
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