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PERMIT APPLICATIO40 <br />BUILDINGAIECHANICAL / PLUMBING / SIGNRINKLER / 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 6438 Cady road Everett, WA 98203-4512 <br />PROPERTY TAX #: 00400000003301 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TadeSSe natrlae) TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET 6438 Cady road <br />CITY Everett STATE WA z1P 98203.4512 <br />OWNER PHONE: 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 0 OTHER (Please Specify) Designer <br />CONTACT NAME: <br />Carmelo N Laviste <br />CONTACT PHONE: 206-6832395 <br />CONTACT EMAIL: cnldesign.drafting@gmail.com <br />BUILDING INFORMATION <br />Existing Use of Building: Single -Family <br />Contract Price of Work: $ 15000 <br />Proposed Use of Building: Adult -Family Home <br />Heat Source: l]Gas ❑Electric []Other <br />BUILDING USE: EISFR ❑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: Convert exist. 3 car garage into 2 bedrooms and living space, 2 bedrooms interior addition, bathroom <br />alterations and existing single family residence at the lower floor into an Adult -family home. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MEBHA <br />PPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Cou <br />List of Fixtures <br />Fixture <br />count <br />t of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C —Air Handling Units <br />Gas Pipin <br />Backflow Preventer side Bldg) <br />1 <br />honer, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothe sher <br />Sink -Commercial (3-c p,prep,floor) <br />hes Dryer <br />Heat Pu tless <br />Dishwasher <br />Sink-Residenti I chen,bath,bar) <br />3 <br />Duct S (Remodel) <br />igeration <br />Drinking Fountain <br />Sink-Uti' aundry, mop <br />3 <br />Exhaust Fans(Rea' ential) <br />Commercial Ven atio <br />(Not Heat/AC Sys m) <br />Floor Drain <br />-Toit6t <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Uri <br />Exhaust Hood (Typ <br />Water Heater <br />Interceptor -Grease <br />WasteMate iping Repair <br />Exhaust Hood esidential) <br />o <br />Interceptor-Sand/Oil <br />Service (behind meter) <br />Forced ystems <br />Other. <br />Medical Gas <br />Water Valvegor Fixtures <br />Ga (replace/Insert/Log <br />Roof Drat <br />1 <br />Water Heater <br />fiHARINKLER / SUPPRESSION <br />SYSTE)ld <br />Sewa jector or sump <br />Other: <br />te S pression System <br />Fchw�-,emical <br />No. of H ds <br />Sbqpression System <br />No. of eads <br />ACKNOWLEDGEbSUZ,.1 have reviewed this applica ' and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and loc 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 / am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PV� 55- <br />Owner/Authorized Agent Signature <br />Date <br />(Revised 1011012018) <br />