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IP PERMIT APPLICAT101110 <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> N.4W CITY OF EVERETT PERMIT SERVICES <br /> 32 00 CEDAR STREET.EVERETT WA 98201 <br /> (Pi 425-257.8810 I FAX 425-257-8857 I(E)eyerettepsq7Peyerettwa gov j ‘vv.v everettwa gov permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4612 S 4th Ave PROPERTY TAX#: 29053200300600 <br /> LEGAL for new constrJctzn Snon',:.ak.sl, N=1;.on Lot No (attach copy of long legal descriphon <br /> CONTACT INFORMATION <br /> OWNER NAME: Tynikki Burkitt TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: %.:REE 7 Same <br /> OWNER PHONE: 425-252-8969 OWNER EMAIL: suga_max@yahoo.com <br /> CONTRACTOR NAME Smart Energy Today <br /> CONTRACTOR ADDRESS: STREEr 2500 Mottman Rd SW <br /> co', Tumwater S TATE WA Z F 98512 <br /> CONTRACTOR PHONE: 360-637-4343 ext.2226 CONTRACTOR EMAIL: victoria.b@smartenergytoday.net <br /> CONTRACTOR LICENSE#tREOLHREDi: SMARTET869RJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 52463 <br /> PRIMARY CONTACT: 0 OWNER VCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Victoria Blunt CONTACT PHONE: 360-637-4343 ext.2226 <br /> Same as above CONTACT EMAIL: victoria.b@smartenergytoday.net <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Home Contract Price of Work:$..... rkciriL-12•'. 1-'24(6••-• <br /> Proposed Use of Byildin9: Personal Space Heat SOurce: OGas °Electric °Other <br /> Building Type: 1SFR-Detachecl OSFP Attached °Duplex 0Muiti-Family-4 of Units: OCommercial Olndustrial <br /> Type of Project:WNew OAdditio Remodel Repair °TA. °Sign °Sprinkler °Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Installation of Solar Panels <br /> ASSOCIATED BUILDING PERMIT#Of 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 #of *of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump T. let _ Backflow Preventer(Inside Bldg, <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory Mash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Dueling 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 1 No. of Heals <br /> ACKNOWLEDGELIEtIT I nave ree,eweo Ms ape on and cvniinn.0-.e:ffortrat;o1)corramed herein is true and correct Work done pursuant to this permt finis!campy',1:1n <br /> current federal state and local law The granting of a peffnif only authonzes approved work and no devrateons therefrom Deviations must hest be tnon n whang from the <br /> 8thIchng Official before being authorized under any citcumstan;:e I am me(Avner or)am authorized by the owner of firs property to perform the work for which application is made <br /> and(comply with the State Contractors Law/8 27 RCW and 296 200A WAC <br /> City of Everett Offcral Use Only <br /> ///. 4„ PERitt Di D...D.3_1 <br /> , 1 0/96020 <br /> Owner/ •• orlzed Agent Signature Date (reviseK21'2)161 <br /> .., <br />