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4:77. 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:8911 Evergreen Way PROPERTY TAX#:003923-000-002-03 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Tom Berg TENANT BUSINESS NAME(Commercial): Velicahn Inc <br /> OWNER MAILING ADDRESS: STREET 12417 36th Ave Se <br /> cry Everett STATE WA zip 98208 <br /> OWNER PHONE: 425.422.2535 OWNER EMAIL:tomberg58@yahoo.com <br /> CONTRACTOR NAME:Neava LLC <br /> CONTRACTOR ADDRESS: STREET 14915 64th Ave W <br /> CITY Edmonds STATE WA zip 98026 <br /> CONTRACTOR PHONE:425.444.1575 CONTRACTOR EMAIL:svin@live.com (gar <br /> CONTRACTOR LICENSE#(REQUIRED):NEAVAL*863BP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � ed- <br /> PRIMARY CONTACT: 1 'OWNER 131 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: : 6\..1,4t. `,_,7 a CONTACT PHONE: <br /> C c o+.1'1'A1ic.—c0R) CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building:Mercantile •Contract Price of Work: $8000 <br /> Proposed Use of Building:Mercantile Heat Source: IZGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair T.I.❑ ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Bring bathroom up to ADA code. Install two doors for entry and exit in the existing large opening, <br /> adding office room. (/kM MI( 14' (1 r—ii/ roar-juaia, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility, laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/InserULog Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed thisapplication 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 laty.�he 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 th grata Contractors Law 18.27 R_CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI <br /> ------; 91 <br /> Owner/• orized.Agent Signature late (Revised 10/100/21018) <br /> 0 <br />