4030 RUCKER AVE 2019-11-14 - Laserfiche WebLink

PERMIT APPLICATION 121 BUILDIN( -IECHANICAL / PLUMBING / SIGN 'RINKLER/ DEMOLITION E V E R E T TCITY OF EVERETT PERMIT SERVICt3 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1'�V 50 KLAA A f Avt. PROPERTY TAX#: li 9557"1 0 i ?)L'I 1 QO LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: IJ �� Y-0\Aq\(jI 1 L.L TENANT BUSINESS NAME(Commercial): es(.-.Lo OWNER MAILING ADDRESS: STREET L)0 � LSCC 3Q u ( tnr,J-(' CITY - .„V CITY •®®® STATE W pc ZIP In.o) OWNER PHONE: ` OWNER EMAIL: CONTRACTOR NAME: g Ak-er 6-1 /e Co,M17�� i CONTRACTOR ADDRESS: STREET 7,{10� Y ( '�I ct q 5 CITY J�(�un_-1- V- .(lT),A lSTA(TE �Pr ZIP a8i 3 CONTRACTOR PHONE: 3Le v-Li 7i f'_13 -S CONTRACTOR EMAIL:S 1 P,' a1-\`1 Z o'-""4-ef5) IA -L(IM CONTRACTOR LICENSE#(REQUIRED):I k-FAFP tJ CV)Z..))S CITY OF EVERETT BUSINESS LICENSE#(REQUIREDi:S 7 I D PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) CONTACTpNAME: CONTACT PHONE: Le 0 -I-�2...1.1 - 1 P' �1,\A1X ( IJI,(\(.. to\S:t" CONTACT EMAIL: S-k-(':f os\it( 6)of\(Ate i S,li't/1 (nivx BUILDING INFORMATION q `1 Existing Use of Building: Contract Price of Work:$ _/00• UD Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: -ECommercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use �/ DESCRIPTION OF WORK: 1# CV W\OE \Oc)5 aems-},N1 ¶43 t}a v p \Ia 1 t c1 s / ae\ c{F1C.,U\ W\W' o,(,Vv 1 ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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 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, and I comply with the State C.ntractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only I V -----79— / � 5-1, 911 j Jj G�/�G► �` ` ✓ ,N I T PERMIT# , l V / ®14 Owner/A thorized •gent Signature Date (Revised 10/10/2018) ,,---1 Ie2 .