912 RUCKER AVE 2018-01-04 - Laserfiche WebLink

• PERMIT APPLICAT'ION• 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� www.everettwa.gov/permits (Blue or Black Ink Anly Please) PROJECT SITE INFORMATIOPI � ROJECT SITE ADDRESS: � � : ` , �`�. PROPERTY TAX#: LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION � OWNER NAME: ` � . ` � . , - �., �,t• � ' TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr ^,,, ��( '� � ��' , CIIY . � r'�.:J.� 1 < STATE � A � ��.• ZIP �! � ,��(: OWNER PHONE: , c� � ^,\,.1 OWNER EMAIL: � ) � r,,n(., • ' " ,r. CONTRACTOR NAME CONTRACTOR ADDRESS: sTREET aTv s ra� ziP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �j�. ,. � (•,,�=� CONTACT EMAIL: =—---- -- � BUILDING PERMIT APPLICATION i Existing Use of Building: Contract Price of Work• �.n.'`�'-� J'' � Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �-----QC6�ercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: f 1- .I '` -- �:� �, \' ,� ; , r.' , j � i"_� � �_ l 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 #°f List of Fixtures Fixtures Fi�cfures Fixtures Fi�ctures A/C–Air Handling Units Heat Pump 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: SPe31�I6SLE�t/SUPP62�SSlO�1 SXS7'EMI Chemical or Water No. of Heads ACKNOWLEDGEMENT:1 have revrewed this application and confirm the information contained herein is true and correct. Work done perrsuant 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 l am authorized by the owner of fhis property to pertorm the work for which applicatron is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � Crty of Everett Official Use Only , � PER� �n _, ( J �� � � � � ,r � � ' " f 1i L�j �� l Owner/Authorized Agent Signature ate (Revised 9/23/2096)