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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Okla or Black Ink Only Pleased PROJJi r:art-INFORMATION <br /> PROJECT SITE ADDRESS: 1521 Rucker Ave PROPERTY TAX#c <br /> LEGAL for new construction: Short Plat/subdivision Lbt No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Tom Treadway TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1521 Rucker Ave <br /> c1Tr Everett STATE WA. zip 98201 <br /> OWNER.PHONE: 425-259-2488 OWNER EMAIL: N/A <br /> CONTRACTOR NAME: Evergreen State Heat&AC <br /> CONTRACTOR ADDRESS: STREET 2120 Pacific <br /> CITY Everett STATE WA. . zip 98201 <br /> CONTRACTOR PHONE: 425-252-3114 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REOUIRED).4„ `~p i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): " <br /> PRIMARY CONTACT: ©OWNER 0 CONTRACTOR 0 OTHER(Please Specify) ken@essmwa.com <br /> CONTACT NAME; CONTACT PHONE 425-252-3114 <br /> Ken Salo CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$4,000,00 <br /> Proposed Use of Building: Heat Source: eiGas CIElectric °Other <br /> Building Type: la SFR-Detached ❑SFR-Attached °Duplex °Multi-Family-#of Units: ❑Commercial Clindustrial <br /> Type of Project: CINew ❑Addition DRemodet ®Repair OT.I. °Sign ❑Sprinkler °Demolition °Change of Use <br /> DESCRIPTION OF WORK: <br /> Change out gas furnace and t-stat <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL•I MIT:APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repair Type of Project: _New _Adds _Alteration _.Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NO—Air Handling Units 1 Heat Pump 1 Toilet 1 Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems 1' Unit Heater 1 Bathtub 1 Urinal <br /> Gas Piping 1 Boiler 1 Lavatory(Wash Basin) 1 Drinking Fountain <br /> Water Heater 1 Refrigeration 1 Shower 1 Floor Drain <br /> 1 Gas Fireplace 1 Wood Stove 1 Kitchen Sink&Disposal 1 Grease Trap <br /> 1 Gas Range 1 Ducting 1 Dishwasher 1 Roof Drains <br /> 1 Clothes Dryer Hookups s1 Other: 1 Clothes Washer 1 Medical Gas <br /> 1 Range Hood 1 1 Water Heater 1 Other: <br /> ) Exhaust Fan 1 I Sink Service/Bar/Mopletc.)\1 Other: <br /> 1 1 1 <br /> SPRINKLER t Si PPRE$SIONAEYSTEM 1 1 <br /> 1 fphemicai or Water fit iNo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application end 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 /> PER <br /> Ken Salo - ' it9)O' -_Vv` <br /> Qwner/Autlterized Agent Signature Date (Revised 9/2311916) r,°' <br />