2923 RUCKER AVE AT YOUR LEISURE 2017-01-13

� � � • PERMIT APPLICATION� BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � wvwv.everettwa.qov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: �� .a �IjL�(C-�(r.. "�(�� C CI �l (.��'* PROPERTY TAX #: LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:G�C E�� d- �/".S� '�%'��' TENANT NAME (If Commercial): �T (�Z/„� �-''�.Sv� OWNER MAILING ADDRESS: sTReer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME; �� j�`%J�� L� � G� C CONTRACTORADDRESS: srREEr �7 ZXi �� %- � �% � �'% CITY SU� �i�j� STATE v!/'! ZIP �� / CONTRACTOR PHONE: ,Z� � —""C�j�Z CONTRACTOR EMAIL: ,�� S� S�Z7ZiS l�/ l�/�%� L' ��' CONTRACTOR LICENSE #(REQUIRED): � � ��L� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):V,�� Z PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: /� �— 2SSO v�j Z ��%�� CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ .!'� Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: � fJ/q��l � � /� /�' i ��,1� L2�1 ��?-S`��I" `�-�� !J `� (..�i � � / ��i�� }S �/�/�r/� fi;�,�>�� . � ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION MBING IT APPLIC N Type of Project: _New _ Addn _Alteration _Repair of Project: ew _Addn teration _Re ir Fixtures List of Fixtures Fixtures List of Fixtures # ures Fixtures ixtures List ur A/C —Air Handling Units Heat Pump T Backf reventer (Insi Idg) Forced Air Systems Unit Heater athtub al Gas Piping Boiler Lavatory s asin) Drinking Fou in , Water Heater Refrigeration ho Floor Drain Gas Fireplace Wood Stove hen Sink & Disp , rease Gas Range Ducting Dis asher rains Clothes Dryer Hookups Other: Clothe Wa e I Gas Range Hood Water er Other: Exhaust Fan in ervi ar/Mop/etc. Other: l%l'J j ` �?�'�� SPRINKLER / SUPPRESSION SYSTEM Number 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 I am authorized by the owner of this property to pertorm the work for which application is made, and I comply with the State Contra�ctors Law 18.27 RCW and 296.200A WAC. gn City of Everett Official Use Only P MT r I (Revised 5/20/2016)