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PERMIT APPLICATION <br />BUILDING MECHANICAL / PLUMBING / SIGN AIRINKLER / DEMOLITION <br />EVERETT 32CITY OF EVERETT PERMIT SERVICES <br />00 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />CONTACT INFORMATION, <br />OWNER NAME: WambU Ann NJUgUna TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 1925 73rd street <br />cITY Everett <br />STATE WA <br />z1P 98203 <br />OWNER PHONE: 678-856-0191 <br />1OWNER EMAIL: <br />CONTRACTOR NAME: Homeowner <br />CONTRACTOR ADDRESS: STREET <br />CITY <br />STATE <br />ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER (Please Specify) Designer <br />CONTACT NAME: <br />Carmelo N. Laviste <br />CONTACT PHONE: 206-6832395 <br />CONTACT EMAIL: carmelola ' e ail.com <br />BOIL©[NG <br />INPORMATIO.N <br />Existing Use of Building: Single-family residence <br />Contract Price of Wo k: $ 20R& <br />La <br />O <br />Proposed Use of Building: Adult -Family Home <br />Heat Source: OGa Electri ❑Other <br />BUILDING USE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑C mercial <br />❑Accessory Structure <br />Type of Project: ❑New ❑✓ Addition ❑✓ Remodel ❑Repair <br />❑T.I. ❑Sign ❑Sprinkler Demolition <br />❑Change of Use <br />DESCRIPTION OF WORK: <br />4 bedrooms interior addition, existing bathroom/laundry room alterations, ramp and existing single family residence into an adult <br />ASSOCIATED BUILDING PERMIT # (if applicable): UACI% <br />/ k�_ <br />MECHANICAL <br />-PERMIT <br />APPLICATIOW <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />Li of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />t of Fixtures <br />A/C — Air Handling Units <br />as Piping <br />Backflow Preventer (Inside Bldg) <br />1 <br />S er, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat 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 />1 <br />Exhaust Fans (Reside i I) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />1 <br />Toilet <br />Exhaust Hood (Typ ) <br />Hose Bibb <br />Urinal <br />Exhaust Hood ( pe II) <br />Water Heater <br />Interceptor-Gre a <br />Waste/Water Piping Repair <br />Exhaust Hoo (Residential) <br />Wood Stove <br />Interceptor and/Oil <br />Water Service (behind meter) <br />Forced Ai ystems <br />Other: <br />Medic as <br />lWater Valves or Fixtures <br />Gas Fi place/Insert/Log <br />Roaf1brains <br />Water Heater <br />SPR KLER;/ 5 ; PPRESSION, <br />SYSTEM <br />ewage Ejector or Sump Pump <br />Other: <br />Water Suppr ssion System <br />I <br />lNo. of Heads <br />Chemical Suppression System <br />I <br />lNo. of Heads <br />ACKNOWLEDGEMENT. I have reviewed this application and confirm the informdtion 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 />1, <br />Owner/Authorized Accent Sianature <br />City of Everett Official Use Only <br />�J P IT� C9© Z <br />Date (Revised 1011012018) <br />v� <br />