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vb‘' if‘c'S PERMIT APPLICATION <br /> AS. \ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa. ov/ ermits <br /> 9 P <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1832 Rucker ave ,PROPERTY TAX#: 00437437101700 <br /> LEGAL for new construction: Short Plat/subdivision dIV g plat 3/1 13-00 Lot No. 1 1,1 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Dave Helgeson TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1832 Rucker ave <br /> TY Everett STATE wa ZIP 98201 <br /> OWNER PHONE: 425-320-7007 OWNER EMAIL: daveh100@me.com <br /> CONTRACTOR NAME: Same <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ci OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-320-7007 <br /> Dave Helgeson CONTACT EMAIL: daveh@me.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Single family res Contract Price of Work:$ 5,000 <br /> Proposed Use of Building: single family res Heat Source: OGas DElectric DOther <br /> Building Type: laSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: __ _ El Commercial Dindustrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.l. ❑Sign DSprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Remove 30" tall retaining wall for 18', grade 18'x36' area, form and pour new parking slab at grade <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> Chemical or Water I No.of Heads _ <br /> ACKNOWLEDGEMEN r:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must coin ply 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 OfficialOfUse Only I <br /> rl � PERMIT# <br /> . piA I ,`J 0 7 - 0 / 5 <br /> I/ ` � 9- 1 <br /> — e � <br /> x%17 r/Aut o ze. gent Sure Date (Revised 9/23/2016) <br />