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g-77PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 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 <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:Shane Lee TENANT NAME(If Commercial): Brentwood Park Apts . <br /> OWNER MAILING ADDRESS: STREET 10 012 4th Ave. W <br /> cITY Everett STATE WA ZIP 98204 <br /> OWNER PHONE: 425-802-5888 OWNER EMAIL: <br /> CONTRACTOR NAME:Mike Grier - Tersuli Construction Services <br /> CONTRACTOR ADDRESS: STREET 2633 Eastlake Ave. E. , Suite 202 <br /> crry Seattle STATE WA ZIP 98102 <br /> CONTRACTOR PHONE: 206-535-8485 CONTRACTOR EMAIL: grier@tersuli . corn <br /> CONTRACTOR LICENSE#(REQUIRED):TERSUCS 8 91DW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 051165 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ®OTHER(Please Specify) Owner ' s Agent <br /> CONTACT NAME:Kyle Bozick CONTACT PHONE: 206-281-7500 <br /> Pacific Engineering Tech. CONTACT EMAIL: kyle@pacengtech.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Apartments (Multi—family) Contract Price of Work: $ $25, 000 <br /> Proposed Use of Building: No Change Heat Source: ❑Gas UtElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ®Multi-Family-#of Units: 53 ❑Commercial ❑Industrial <br /> Type of Project: El New DAddition DRemodel ®Repair ❑T.I. DSign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Repair of damage to exterior walkway stairwell and Unit 101 wall <br /> framing from vehicle impact. <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 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 /> 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 /> 94),, PVT <br /> # <br /> Ow.? lgP <br /> I�G� V� (1ba' 024 <br /> Owne Autb.krized Agent Signature Date (Revised 10/12/2015) <br /> fly <br />