2928 RUCKER AVE 2021-04-01 - Laserfiche WebLink

� PERMIT APPLICATIO BUILDING' JIECHANICAL / PLUMBING /SIGN RINKLER/ DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: Z9 Z e 1,VG1z6 l2 AV L PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: M LC,1r re II & t L V TENANT BUSINESS NAME(Commercial): /N.1 Z S 14 U 3O0TSGt U(; OWNER MAILING ADDRESS: STREET 9 Z9?) Q.4.3 c c A\/E CITY L vC 12e Tr STATE \/( A ZIP 9 Cam.// OWNER PHONE: %2 - as-7- 3 1 ( Q OWNER EMAIL: CONTRACTOR NAME: 1,M F 12A Coc.> J; S g VVc-E s L LC_ CONTRACTOR ADDRESS: STREET /4!/03 S rr;lic/4 T- /2-0 CITY m Ait IL STATE \yij,4 ZIP 983 90 CONTRACTOR PHONE: y2s1Lst6 y3 98 CONTRACTOR EMAIL: 1p y, 4-(,c;----)o vc-ito-/2SC' ..CCY71 CONTRACTOR LICENSE#(REQUIRED):_rA/F/ se, g 7 i Cgs._ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):QS 1 9OS PRIMARY CONTACT: 0 OWNER ['CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: f� �/ CONTACT PHONE: Ll 2 ' - S`�p , 4/J 'k �i 1� 1 l .c >C4A(0 - 7L CONTACT EMAIL6D(jl ,/. AC,cl ?CA/l!()C 4._ IDS CO 4? BUILDING INFORMATION Existing Use of Building: Contract Price of Work:$ / c OG Proposed Use of Building: Heat Source: , Gas ❑Electric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: commercial DAccessory Structure Type of Project: ❑New gAddition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use DESCRIPTION OF WORK: Re-ci, T r-6,j OF re f,L 6.1.47.5 ".7 6...,7--:-/c 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 NC—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 Ventilation 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 comp) • the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Y—o`. zo P 03_ 0232, Owner/ uthorized Agent ignature Date (Revised 4/15/2019)