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4111 PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER/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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1503 Virginia Ave Everett WA 98201 PROPERTY TAX#:29051700300400 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Elyse Kufeldt TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1503 Virginia Ave <br /> cin Everett STATE WA zip 98201 <br /> OWNER PHONE: 425-246-5059 OWNER EMAIL:elysekuf@gmail.com <br /> CONTRACTOR NAME:R&R Foundation Specialist <br /> CONTRACTOR ADDRESS: STREET 3409 McDougall Ave Suite 204 <br /> cliv Everett STATE W@rrsApecialist.net <br /> 98201 <br /> CONTRACTOR PHONE:425-626-4841 CONTRACTOR EMAIL:barbara@rrspecialist.net <br /> CONTRACTOR LICENSE#(REQUIRED):RRFOUFS829DA CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): 58143 <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-626-4841 <br /> Barbara Stasiak CONTACT EMAIL:barbara@rrspecialist.net <br /> BUILDING INFORMATION <br /> Existing Use of Building:SFR (Contract Price of Work:$25,901.25 <br /> Proposed Use of Building:SFR Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: LJNew LJAddition LJRemodel LJRepair LJT.I. LJSign LlSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: crew will install concentric piers , 6X6 adjustable post bases with pads to stabilize and lift foundation <br /> to maximum practical recovery <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> I Fixture I I Fixture <br /> Fixture I List of Fixtures Fixture Lict ref Fixtures List of Fixtures List of Fixtures <br /> count count 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 /> I 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 VentilatiO_ 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 /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I 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/am authorized by the owner of this properly 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#tJn�\2� O 31 <br /> '�a4uL �ti 12/11/2020 V' <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) Vz <br />