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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> ZifOltMgligr <br /> PROJECT SITE ADDRESS:4822 Rucker Ave PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: Karl Rabel TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4822 Rucker Ave <br /> CITY STATE wa ZIP <br /> OWNER PHONE: 4256 609 1912 OWNER EMAIL: krabelicon@gmail.com <br /> CONTRACTOR NAME: Axiom hvac <br /> CONTRACTOR ADDRESS: STREET 2232 Broadway nn / <br /> CITY Everett STATE V V 1rT zIP'7 ZG/ <br /> CONTRACTOR PHONE: 425 512 9689 CONTRACTOR EMAIL: Daron@axiomnw.com <br /> CONTRACTOR LICENSE#(REQUIRED): AXIOM189RM CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):54279 <br /> PRIMARY CONTACT: 0 OWNER P, ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425 879 5351 <br /> Daron Smith CONTACT EMAIL: ()GLs- c1( ) Y/0 14,1 11 I,1":„.BGG 1 <br /> adam:'' <br /> Existing Use of Building: Contract Price of Work:$ u l %), <br /> Proposed Use of Buildi • Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: R-Detached ❑SFR-Attached ❑Duplex �❑M�ulti- ❑ <br /> Family-#of Units: ❑Commercial Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair �rri. bSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> install ductless heat pump with 4 indoor units <br /> ASSOCIATEDyBUILDING PERMIT#(if applicable): <br /> �y ■4jyy (��y YCX w� •■ �`y <br /> !T'11'T S � ® .'„ ,./ti>,.- s3 4 q/�'F I I�U ,.,,�,- '^' 'R^'' .. R,• .,�"+ .^. !`.„,, 3 • �,F r, s`, <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handlin• Units "Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air S stems —Unit Heater Bathtub Urinal <br /> Gas Pipin• —Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri•eration Shower Floor Drain <br /> Gas Fireplace —Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range —Ductin• Dishwasher Roof Drains <br /> Clothes D er Hookups —Other: Clothes Washer Medical Gas <br /> Ran.e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> " ,. .-li.. E10PP> SSIoN <br /> Number of Heads <br /> 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 <br /> 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 <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7---/ 7 PERM#� (D <br /> b�� <br /> Owner Authorized Signature Date (Revised 9/23/201 ) <br />