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0 PERMIT APPLICATION <br /> • <br /> ILI <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2222 BAKER AVE, EVERETT WA 98201 PROPERTY TAX#:00401 5471 021 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: SAISHANKAR MADANAGOPALAN TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET412 242nd PL NE <br /> CITY SAMMAMISH STATE WA ZIP 98074 <br /> OWNER PHONE: (817) 881-8883 OWNER EMAIL:saishankar@outlook.com <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑� OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(817) 881-8883 <br /> SAISHANKAR MADANAGOPALAN CONTACT EMAIL:saishankar@outlook.com <br /> BUILDING INFORMATION ___ <br /> Existing Use of Building: Single Residential Contract Price of W 2—Ce Fi <br /> Proposed Use of Building: Single Residential Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: I]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: STRUCTURAL UPGRADE ONLY. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count Li of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gia s Piping Backflow Preventer(Inside Bldg) S wer,Tub,or Combo <br /> Boiler ,,'Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer re` Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain <br /> °'� Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) / Commercial Ventilatior Floor Drain Toilet <br /> / <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/oiler' Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas✓.V Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> 6JJ2CZO (,J .2Wq -CO <br /> Owner/Authorized Agent Sig re Da (Revised 10/ 018) "� <br /> w v - co ( ,ry <br />