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. PERMIT APPLICATION • <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />OOL (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1 819 Rucker Ave <br />I PROPERTY TAX #:0043803700900 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Emily Dagg TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREETaS above <br />CITY STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: 0C,/j1\-Pir <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER (Please Specify) Designer <br />CONTACT NAME: <br />Rod Wickham <br />CONTACT PHONE:425 252 2789 <br />CONTACT EMAIL:Rad.design@hotmail.com <br />BUILDING INFORMATION <br />Existing Use of Building:SFR <br />Contract Price of Work: $ <br />Proposed Use of Building: SFR <br />I Heat Source: []Gas ❑Electric e 00ther <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑✓ Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />Add an upper story and remodel the main floor. <br />ASSOCIATED BUILDING PERMIT # if applicable : <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />cau�t <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />3 <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />i <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />I <br />Clothes Dryer <br />Heat Pump&Ductless <br />i <br />Dishwasher <br />3 <br />Sink -Residential (kitchen, bath, bar) <br />r <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />1 <br />Sink -Utility, laundry, mop <br />4 <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />2 <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />1 <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />I <br />l0ther: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />I <br />I <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. 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 1 am authorized by the owner of this property to perform the work for which application is made, <br />and �Icomply with t State Contractors Law 18.27 R nd 296.200A WAC. <br />11 City of Everett Official Use Only <br />j PERMIT <br />O, <br />Own`erlAu oriterl Agent Signature Date (Revised 10/10/2018) <br />�7_ <br />