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• • <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING / SIGN /SPRINKLER 1 DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I w,vw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2925/2927 Rucker Ave PROPERTY TAX#:004391 681 01 1 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Rick Lapinski TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREETPo Box 1978 <br /> cn-Y Everett STATE WA Z,P 98206 <br /> OWNER PHONE:425-330-7773 OWNER EMAIL:rick@rickre.Com <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: 5-FREE: <br /> On% STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building:Retail, Warehouse,Auto Repair Contract Price of Work:S <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other_ <br /> BUILDING USE: ❑SFR `:Townhouse Duplex i`iADU EMulti-Family-#Units: _ ECommercial LiAccessory Structure <br /> Type of Project: `New Addition Remodel 1Repair !''T.I. i_.Sign LSprinkler E'Demolition EChange of Use <br /> DESCRIPTION OF WORK: Fire damage walk through <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures coca List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backfiow 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 Ventilation Floor Drain Toile: <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) \Nate•Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oi: 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 /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump oilier: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System :No of Heads <br /> ACKNO WLEDGEMENT: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 /> PERMIT# <br /> 1/17/20 <br /> OwnefilAuthorAgerif Signature Date (Revised 10/10/2 1. <br /> 0 8) <br />