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�� <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />AOORESS: <br />1611 Rucker Ave, Everett. WA <br /># <br />for new construction: Short PlaUsubdivision _ _ Lot No.___ (attach copy of long legal description) <br />Bruce G Eklunc <br />1611 RuckerAve <br />�fT: X Owner <br />25.446.1757 bbeklund <br />Everett, WA 98201 <br />Owner's Agent _ Contractor _ Contractor�S A92flf _ T8f12f1( (must provide alelter ol consent trom the owner to do v.ork in thc <br />CONTRACTOR GM Heating <br />aad�ss 1?15 Broadway, Everett, WA 98201 <br />BUILDING PERMIT APPLICATION <br />State Lic. # C��IHEAI'095R4 Citv Bus. Lic. # <br />+PhonelEmail 425.312.6833 <br />F�R PERMIT <br />T PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Buiiding Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project: New Addition Remodel Repair T.I. Si n Sprinkler Demolition Chan e of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />Ir-� ���1(E' ;,`�;i��i �' �1�,�,>I-��/ <br />MECHANICAL PERMIT APPLiCATION PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handlinq units <br />Forced air systems <br />Gas piAinq <br />ace Water heater <br />Gas firepiace <br />Gas ranqe <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriqeration <br />Woodstove <br />Ductinq <br />Other <br />SPRINKLER ! SUPPRESSION SYSTEM <br />Number of Heads <br />of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Shower <br />Kitchen sink & t <br />Dishwasher <br />Clothes washer <br />Water heater <br />Backflow preventer (inside <br />Urinal <br />Drinking Fountain <br />Floor drain <br />hledical Gas <br />Other: <br />Other: <br />t hereb rtdy that I have read and ezamine this applicatio know the same to be trve and correcL All provisions of laws antl ordinances governing Uis type of work will be comp�. <br />with her specified he -n or not. e ranlin of a pe it do s not presume to give authodty to valate or cancel the provision of any other slate or local law regulating construction <br />Th m authorized by ne op to perf rm the work for which application is made and I comply with Ihe Stale ConVactors Law 18.27 RCW and 296.200A WAC. <br />Z�L� 9,�7; ?5 <br />OwnerlAuthorizeif Agent ig�ature Date (Revised 4/2015) <br />