1502 RUCKER AVE 2017-10-25 - Laserfiche WebLink

• PERMIT APPLICATIO, BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1 5CZ 1PROPERTY TAX#: vC) J -3 t,C LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: �C�-� C��(� �� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREET CITY t✓ �"�:'� STATE �!`/rV� ZIP OWNER PHONE: - OWNER EMAIL. CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 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: P up Z 110 ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New Addn _Alteration _Repair Type of Project: _New -!,,�-Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Units Heat Pump i Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Number of Heads ACKNOWLEDGEMENT:/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.l w— he granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before dein a on ed under any circumstance./am the ow er,or authorized by the owner of this property to perform the work for which application is made, and I comply with h Stat tra ors Law 98.27 RCW and 296.200A WA City of Everett Official Use Only „w PERMIT# w(�O, I ©�3 Owner/Au&&A66 Agent Signature D e (Revised 5/20/2016)