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PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING /SIGN I SPRINKLEIk I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (K425-257-8810 I FAX 425-257-8857 f(E)eVatiattepeetaVereityva.gov i.V r ,gov/permits <br /> 7f17'11'''' P = '-:* 4RMMtO t z <br /> --''',—PROJECT SITE AO-DRESS: •ROPERTY TAX fl. <br /> 2126 Rucker Ave 00439143201900 _.._ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> *A,7.tp1: 4t Otit{ <br /> OWNER NAME: Diana Lynn TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET2126 Rucker Ave <br /> ciTM Everett STATE WA ZIP 98201 <br /> OWNER PHONE:425-941-8087 OWNER EMAIL: <br /> CONTRACTOR NAME:WASHINGTON ENERGY SERVICES <br /> CONTRACTOR ADDRESS: STREET 3909 196TH ST SW. <br /> crry LYNNWOOD STATE WA.: ZIP 98036 <br /> CONTRACTOR PHONE:x'06-378-6648 CONTRACTOR EMAIL:vstephenson©washingtonenegy.com <br /> 0014TRAcT0R LICENSE#(REQtttNER t1 WASHIES851NS 1 OF EVERETT BttNt?$S LICENSE ;,UIRE = 54773 <br /> . <br /> PRIMARY CONTACT: O OW..m CON <br /> . oft <br /> - _ . .,�' �• �: .•..<` <br /> =.' ❑OTHER(Please Specify) ,, <br /> CONTAGT NAME; CONTACT PHONE 206-378 6648 <br /> Vanessa Stephenson - <br /> CONTACT 0 ep �hingtonenergy.com <br /> a <br /> 0 is l a se of„° its= ,Contract Price of i •rit s.� ._. <br /> Prc•osadUse ofBuildint: ,, : otat . -s DElectric QOther <br /> Buildine T ■ ;SFR tached Cbu lex 1:1Multi-Family-#of;U81ts:- Ej,ponuniarcittl, Elindustrial <br /> . fP • w ❑Nei: 15Mdlti• - ORemodel CIReptilt :.OT,1. r:i$1411 CIS rirlit ' Otj01111#0 E hglilgtitofUse <br /> o•-SCRI : .',or WORK: <br /> ASSOCIAT P B II-DING F' RMIT#(if eppIicable) <br /> r <br /> 5 I0 9 ,wi �� Y t i 1 4' � ,, <br /> Sp _..� '�"� �e wen' ..., r <br /> Typoof Project _New _, Addn fj*itei*ition Repair • Type of Project __New _Addh II Iteration _Repair <br /> #of #of #o/ #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Hendlllnia Unite • i Heat Pump Toilet Backflow Ireventer(inside BId$) <br /> FottetAkSyttterns. Unit Heater athtut) sinal <br /> Gas Piping Boiler Lavatory( ) Drinking(Wash Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> 'Gas Fireplace - Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting • Dishwasher Roof Drains <br /> Clothes Drier HookupsOther Clothes Washer Medical Gas <br /> Range Hood , Water Heater Other <br /> (... <br /> /etc. _ Other. <br /> Exhaust Fan - Sink(Service/Bar/Mop/etc, <br /> 1Nun'Iber.of Hees <br /> ACKNOWLEDGEMENT:I have nwviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit roust 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,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 ROW and 296.200A WAC. <br /> iyof Everett Official Use On <br /> PERK h�# <br /> V Stephenson o 21. •tinea eyv rn.., ,7„-"e' V" i <br /> Vanessa Stephenson •LUEa:29k1 tE9Gf%T tAAt dt9'iXt 11/10/17 � ; -... -' ® , <br /> Owner/Authorized Agent Signature Date {4'>,0'# 1 or 01' <br />