3604 RUCKER AVE 2022-02-16 - Laserfiche WebLink

44-77 PERMIT APPLICATION BUILDING I MECHANICAL I PLUMBING/SIGN 1 SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 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:3606 RUCKER AVE PROPERTY TAX#: 00451401303000 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT:INFORMATION OWNER NAME; RAY GURZYNSKI TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 3606 RUCKER AVE crrY EVERETT STATE WA zip 98201 OWNER PHONE: (206)240-5720 OWNER EMAIL: CONTRACTOR NAME:GS HEATING CONTRACTOR ADDRESS: STREET3409 EVERETT AVE cry EVERETT STATE WA zip 98201 CONTRACTOR PHONE:425-610-4257 CONTRACTOR EMAIL:MELANIE@GSHEATING.COM CONTRACTOR LICENSE#(REQUIRED):GSH EAHC821 QR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60058 PRIMARY CONTACT: ❑OWNER El CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-610-4257 MELANIE MENDENHALL CONTACT EMAIL:MELANIE@GSHEATING.COM BUILDING INFORMATION • Existing Use of Building:RESIDENTAIL Contract Price of Work:$3066.52 Proposed Use of Building:RESIDENTAIL Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: 1]SFR ❑Townhouse ❑Duplex DADU ❑Multi-Famiry-#Units: ❑Commercial ❑Accessory Structure Type of Project: DNew ❑Addition ❑Remodel DRepair OT.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use DESCRIPTION OF WORK: WALL FURNACE REPLACEMENT ON MOTHER-IN-LAW PROPERTY(3604 RUCKER AVE) ASSOCIATED BUILDING PERMIT#(if applicable): • MECHANICALPERMIT:APPLICATION . PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures count 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 Ventilatior 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!am authorized by the owner of this property to perform the work for which application is made, and!comply with the State Contractors Law 18.27 RCW end 296.200A WAC. PERM � I 0 f ,,,� City of Everett Official Use Only OwnerlAut}fdtized Agent Signature Date (Revised1000/104018)