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0 PERMIT APPLICATION <br /> 111.1 BUILDING / MECHANICAL/ PLUMBING /SIGN / INKLER/DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASH I N GTON (P)425-257-8810' I FAX 425-257-8857 I(E)everettepsigeverettwa.gov I www.everettwa.gov/pemnits <br /> PROJECT SITE ADDRESS:5102 27th Ave W PROPERTY TAX#:00564200000100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. <br /> (attach copy of long legal description) <br /> ,p� ' ,, O,NtACT Iil FOR ATION O .. - ., .. . . <br /> OWNER NAME: Richard Walker TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 5102 27th Ave W <br /> ow Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425-269-4817 OWNER EMAIL: <br /> CONTRACTOR NAME:R&R Foundation Specialist <br /> CONTRACTOR ADDRESS: sTREET3409 McDougall Ave Suite 204 <br /> cm Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:425-626-4841 CONTRACTOR EMAIL:barbara@rrspecialist.net <br /> CONTRACTOR LICENSE#(REQUIRED):RRFOUFS829DA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 58143 <br /> PRIMARY CONTACT: ❑OWNER D CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-626-4,41 <br /> Barbara Stasiak CONTACT EMAIL:barbara I% speci- ist.net <br /> Existing Use of Building:SFR Contract Price • ork:$18,052 <br /> Proposed Use of Building: Heat Source: •Gas ❑Electric ❑Other <br /> BUILDING USE: ESFR (]Townhouse ❑Duplex ❑ADU (]Multi-Family-#Units ❑Co ercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑✓Repair ❑T.I. ❑Sign • prinkler ❑P-molition ❑Change of Use <br /> DESCRIPTION OF WORK: crew will install helical piles to stabilize and lift home t. - mum practical recovery <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL 00111 " 'Pi ICATION na goniggYoptutootgkotitmerPLUMBINGAOMOMIONMPOPOSAI <br /> Fixture Fixture List of Fixtures Fixture List of Fixtures <br /> Count List of Fixtures Fixture List of Fixtures Count Count <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> Mige4S*RIN L E'R!SlWPIt> SION SYSTEllll Sewage Ejector or Sump Pump Other: <br /> Water Suppression System y No.of Heads <br /> Chemical Suppression System 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 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 Official Use Only <br /> 'ar a/La. c5'ta-.1-1 t 9/14/2020 PERMS( 0‘O I cot"2............. <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />