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PERMIT APPLICATION <br /> "IPBUILDING / MECHANICAL i PLUMBING 1 SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 10 012 4th Ave . W. PROPERTY TAX#:28042400201900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Brentwood North, LLC c/o Yan Ling Li TENANT NAME(if Commercial): Brentwood Park Apts . <br /> OWNER MAILING ADDRESS: STREET 6191 118th Ave . S .E. <br /> cmm Bellevue STATE WA zip 98006 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:Mike Grier - Tersuli. Construction Services <br /> CONTRACTOR ADDRESS: STREET 2633 Eastlake Ave . E. , Suite 202 <br /> CITY Seattle STATE WA ZIP 98102 <br /> CONTRACTOR PHONE: 206-535-8485 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):TERSUCS 8 91DW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR ®OTHER(Please Specify).,Owner' s Agent <br /> CONTACT NAME: Chris B a cus CONTACT PHONE: 2 0 6-2 81-7 5 00 <br /> Pacific Engineering Tech. CONTACT EMAIL: cbacus@pacengtech.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Apartments (Multi-family) Contract Price of Work:$ <br /> Proposed Use of Building: No Change Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached CI SFR-Attached ODuplex ®Multi-Family-#of Units: 53 ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ®Repair DT.I, ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Damage assessment for vehicle impact damage to unit #101 <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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 Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting ' Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> W <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 /> � � 2)12-�j/�p 1 in, - 00s <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />