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� PERMIT APPLICATIO " <br />BUILDINGTVIECHANICAL / PLUMBING / SIGN RINKLER / 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: 6722 HIGHLAND DR. EVERETT, WA 98203 <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: PAULINE WANIRU TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: s11EET6722 HIGHLAND DR. <br />c,Tv EVERETT STATE WA ziP 98203 <br />OWNER PHONE: 206-823-5559 <br />OWNER EMAIL: panilladean@gmail.com <br />CONTRACTOR NAME: owner / PAULINE WANJIRU Ur R p # � L Wi � <br />CONTRACTOR ADDRESS: STREET6722 HIGHLAND DR. <br />CTv EVERETT STATE WA Z,p 98203 <br />CONTRACTOR PHONE:206-823-5559 <br />CONTRACTOR EMAIL: panilladean@gmail.com <br />yy <br />CONTRACTOR LICENSE #(REQUIRED): (mic""S I li R <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />pauline wanpru <br />CONTACT PHONE:206-823-5559 <br />CONTACT EMAIL: panilladean@gmail.com <br />BUILDING INFORMATION <br />Existing Use of Building: Resident <br />Contract Price of Work: $ 10,000. <br />Proposed Use of § ilding: Adult Family Home ' <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR __T7l ownTiouse ❑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: INTERIOR GARAGED MODIFICATION ADD 3 ROOMS, BATHROOM, INFILL GARAGE DOOR <br />WITH 2 X 6 EXTERIOR SHEAR WALL R21 INSUL, ADD 2 60" X 48" WINDOWS, A TOTAL OF 389 SQ FT IS THE SCOPE <br />OF WORK. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <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 />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />N/A <br />A/C — Air Handling Units <br />N/A <br />Gas Piping <br />N/A <br />Backflow Preventer (Inside Bldg) <br />X <br />Shower, Tub, or Combo <br />N/A <br />Boiler <br />N/A <br />Gas Range <br />N/A <br />Clothes Washer <br />N/A <br />Sink -Commercial (3-comp,prep,floor) <br />N/A <br />Clothes Dryer <br />N/A <br />Heat Pump&Ductless <br />N/A <br />Dishwasher <br />N/A <br />Sink -Residential (kitchen, bath, bar) <br />N/A <br />Duct System (Remodel) <br />N/A <br />Refrigeration <br />N/A <br />Drinking Fountain <br />N/A <br />Sink -Utility, laundry, mop <br />100cfm <br />Exhaust Fans (Residential) <br />N/A <br />Commercial Ventilatio <br />(Not HeaUAC system) <br />N/A <br />Floor Drain <br />N/A <br />Toilet <br />N/A <br />Exhaust Hood (Type 1) <br />N/A <br />Hose Bibb <br />N/A <br />Urinal <br />N/A <br />Exhaust Hood (Type II) <br />N/A <br />Water Heater <br />N/A <br />Interceptor -Grease <br />N/A <br />Waste/Water Piping Repair <br />N/A <br />Exhaust Hood (Residential) <br />N/A <br />Wood Stove <br />M/A <br />Interceptor-Sand/Oil <br />N/A <br />Water Service (behind meter) <br />N/A <br />Forced Air Systems <br />Other: <br />N/A <br />I Medical Gas <br />N/A <br />Water Valves or Fixtures <br />N/A <br />Gas Fireplace/Insert/Log <br />N/A <br />Roof Drains <br />I N/A <br />lWater Heater <br />SPRINKLER / 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. 1 am the owner, or 1 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 />Owner/Authorized Agent Signature %Ore. <br />�'e 0/8i�- D�� <br />AAM16«+ k00 <br />