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PERMIT APPLICATIOPS <br />BUILDINGECHANICAL / PLUMBING / SIGNRINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 l FAX 425-257-8857 l (E) everetteps@everettwa.gov l www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1925 73rd Street SE Everett, WA 98203 <br />PROPERTY TAX #: 28050800204000 <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Wambu Ann NJuguna TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 1925 73rd street <br />cIT„ Everett STATE WA zip 98203 <br />OWNER PHONE: 678-856-0191 <br />OWNER EMAIL: <br />CONTRACTOR NAME: Homeowner <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR El OTHER (Please Specify) Designer <br />CONTACT NAME: <br />Carmelo N. Laviste <br />CONTACT PHONE: 206-6832395 <br />CONTACT EMAIL: carmelola a ail.com <br />BUILDING INFORMATION <br />Existing Use of Building: Single-family residence <br />Contract Price of Wo k: $ 2 0 • <br />Proposed Use of Building: Adult -Family Home <br />Heat Source: I]Ga Electri ❑Other <br />BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑C mercial ❑Accessory Structure <br />Type of Project: ❑New ❑✓ Addition ❑✓ Remodel ❑Repair ❑T.L ❑Sign ❑Sprinkler Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />' '=•' - �� inn hathrnnm/lain - altera <br />ASSOCIATED BUILDING PERMIT # (if applicable): kk- <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />count <br />List of Fixtures <br />FIX <br />Count <br />list of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas ge <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />at Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (ResidentjAW <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Ty <br />Hose Bibb <br />Urinal <br />Exhaust Hoo ype II) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaus od (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />For d Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />as Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER l SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />No. of Heads <br />Chemical Suppression System <br />No. 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />7, --c <br />Date (Revised 1011012018) <br />