5025 RUCKER AVE 2016-10-06 - Laserfiche WebLink

� PERMIT APPLICATION � BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER J DEMOLITION CiTY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � w�wv.everettwa.gov/permits PROJECT SITE INFORMATION PROJEC7 SITE ADDRESS: �^O� � K C r� PROPERTY TAX #: a!� Q S.3 / O O D��O O ,�J LEGAL for new construction: Short Plat'subdivision Lot No. {a;tacn copy of long legal descriptlon) CONTACT INFORMATI�N OWNER NAME: ,,,5 a„ r dl C l� Q r' G� t TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srREer S G� 11�(.� � S YC ��.°C cin' sr,are ziP OWNER PHONE: � ^— 3 � ,3 ��' OWNER EMAIL; `J �G� ✓� yt � �y1 j t /y( ��1 , �, p y^, CONTRACTOR NAME; j fi D n �'Q.�r M y' SYIe Ct ��' z►1 G. CONTRACTOR ADDRESS: s-Ree- pD 7S^� _ a a 13 ).� 1 K� ✓t C� ��r � 5��,�s STATE c�� ZP 4ga S- CONTRACTOR PHONE: 5� 3,35' a,O CONTRACTOR EMAII.: �1�' � �O /'1 rl @4 ir� � �0�'rl,C/: C CONTRACTOR LICENSE #(REQUIRED): K�G %�, g8 eM CITY QF EVERETT BUSINESS LICENSE #(RE UIRED):O 3�� PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: a s �" 1�. d �"�' �e.C�l^ ( e ��-a-� � S CONTACT EMAIL: �^ t h"�'Qy1 �,eQ-f- �` � lOh � ei Ce K, BUfLDiNG PERMIT APPLICATION Existing Use of Building: Contract Prlce of Work:; �� v-`� Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Aftached ❑Duplex ❑Multf-Famlly-# of Units; ❑Commeroial ❑Industriai Type of Project: ❑New ❑Addition ❑Remodel ❑Repair OT.I. ❑Sign ❑Sprinkler ❑Demolitlon ❑Change of Use dESCRIPTION OF WORK: � ` � L Q.5 P i rJ r vl �'a-t�- yvl.e.�'er `�a :!^Gc.nq.e,� �-t.o wa er � � �L��fc+; -�' �lp i nse�-t' CJ ASSOCIATED BUILDING PERMIT # (If appllcable): ACKNCWLEDGEMENT; ! have revrewed fhls applicatlon and confirm the /nfamation cwrtained hereln Is true and carecf. Work done pursuant to fhis permit must compry with currenl lederal, state, and local law. The grantrng of a permit onfy authcx/zes approved worlc and no deWetions therefrom. Devratrons must firsf be authaNzed 1n wr'rtrng ,hom the BuUding OHic;a! befcre being authorrzed under any crr�ums7ance. ! am the owne�, or / am authaized 6y the owner o�thrs property io perfam the wcrk fa whrch appllca7lon rs made, snd 1 cornply �vlth the State Confractors Law 18.27 RCW and 296.200A WAC. Cify of Everelt 0/fk;a! Use Only � / � PERMIT �� �- !3 - - 0 erlAuthorized Agent S gnature Date !Revrsod 1 D/12/2015}