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/1111PIP' "ET APPLICATI0M <br /> BUILDING!'MECHANICAL/PLUMBING!'SIN!SPRINKLER I DEMOLITION <br /> tiotgai CITY OF.EVERETT PERMIT'SERVICES <br /> 3200CEDAR: TREET,EVERETT, A:98201'. <br /> (P)426457.8840 I FM 425=2574.857 ( }eu asps erott .ger I•u 'everettwa gov perrnits <br /> PROJECT SITE ADDRESS: 3003 18th Bt,Everett,:WA:98201 0110 PERTV TAX#: '00605400400100 <br /> LEGAL for new construction: Short filet/subdivision Lot No: tattaoh copy of lono;legal'd riptton). <br /> OWNER NAME. Peg V Thompson TEtiAlII NANia(if C;omn>aercial): <br /> ' OWNER MAMLING•ADDRESS: $ThEET' 3003 18th St <br /> crrY Everett STATE WA zip 98201 <br /> ,OWNERPHONE: 425-232-3737 LOWNER.EMAIL Back4oc@titan coat <br /> ,.. ,,,. . ... . ... ...... 'rte-�_.,�...�...� �.., ., <br /> CONTRACTOR NAME.: Back Forty Construction,.LLC <br /> CONTRACTOR ADDRESS: sneer 27419 118th St--SIS <br /> crr/ Monroe sere WA ZIP 98272 <br /> CONTRACTOR PHONE: 36O-793-2899 <br /> �, �. . . .:__.GO.NT. RAM.CTOEMA1L Back4Qr .rr ncom <br /> - R <br /> CONTRACTOR LIENSE it¢ EIRE : BACKFFC914P6CF'OF EVEISLIMNESSLICE <br /> LICENSE#REQlR ) 54 0R U <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR CI OTHER(Please Spe Y? _ <br /> CONTACT NAME: C©NTACTPH NE: 4264323737 <br /> Mike Clothier CONTACT EMAIL: Bar✓k4OoC msl'1- <br /> -k� ra .a � 1 tc , 7- - fl Mao- g .-ce� �- `- <br /> Existing Use of Building:!Residential . Contract Price of Work:S 7460-°0 <br /> Proposed.Use of Building:.SNirj , Heat Source:. OGas. CiEIe EatAber <br /> Building Type: SFR Detached °SFR;Attached ODuplexx: DMulti-Family4 of Units: CIC.orttnisrciai ,ljtndustrial <br /> Type of Project ClNew °Addition ORemodel CIRepair EIT.i: OSign: ©Sprinkler QDernolifion E Change of Use <br /> DESCRIPTION OF WORK: <br /> Re Roof <br /> ASSOCIATED BUILDING PEl MIT;#tif appiica*_ <br /> Type of Project:__,Neer Addy Alteratton Repair Type of Protect ,New Adrift _Alteration j epair' <br /> S itof itof #At <br /> Fixtures' List ofi``tar tt es FfactYrr es list of aures L 1St ofi 3rtrtres List of Flxtrires <br /> rooftree adores, <br /> NC—Air-Handling Units" Neat Pump _ 'f rilet' Bet 0w'Preventer(ins Ekt) <br /> Forced'Air Systems _Unit Heater Bathtub Uri,... <br /> nal <br /> Gas Piping. Boiler . Lavatoiy(Wash Beein) .Dnrikirig,Fountain <br /> ' Water Heater Refrigeration Shower Floor Drain <br /> 'Gas Fireplace Wood Stove' Kitchen Sink&Disposal :-Grease Trots: <br /> Gas Range Ducting Dishwasher Reef brains= <br /> Clothes Dryer HootcupsOther: Cloth hasher Medical Gas <br /> Range Hood WeterHeater' Other:: <br /> Exhaust Farr hink(Service/BariMopfetc.), "Other <br /> Mid „...NK,AR'..„ Ag111, ,: kAl : <br /> Chemical or Water 1 Na,of Heads <br /> ACIC/NOWLE0(EtiEENT•I havereviewed this application and confinn the Information contained herein is true and cermet Work donegturrsuont tothispenrairt mtist comply with <br /> currentfederaleatate. and local law The granting of a pent*on4/autherizes approved work and nerthaWationstherefrom,Deeraroeismustfirstbeeu"thonzeditrwriting•tromthe' <br /> Buddin9,O(lciat before tieing authorized tnderany-cl cumstance l aril the owner,or l ate authorized by the owner athis0Operty 6 perform the workfor which application is made,; <br /> and I comply withithe C ntractora Law t;, alfa'290200A WAC. <br /> PERMIT' , ky ctre_-rettIFffTjtfl.se <br /> .I <br /> Crfy <br /> 3v U.J <br /> OwwnertAdthorized'Agent Signature Oete (Rev seii-9/2 018) <br />