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MI • PERMIT APPLCCATOOP• <br /> BUILDING/MECHANICAL i 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 Plsaao) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:5611 COLBY AVE, EVERETT WA 98203 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ADAN&DEBORA L BALANGUE TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 5611 COLBY AVE, <br /> ary EVERETT STATE WA ZIP 98203-3830 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:TBD 0 ok wit. 13,0' ,2/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): IAA AC K 6 S 0-1..241.3 a CITY OF EVERETT BUSINESS LICENSE!!(REQUIRED):5 39(07 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) AGENT <br /> CONTACT NAME: CONTACT PHONE:425 478 9013 <br /> JUAN MOLATO CONTACT EMAIL:jimolato@yahoo.corn <br /> BUILDING INFORMATION <br /> Existing Use of Building:ADULT FAMILY HOME Contract Price of Work:$100?00 <br /> Proposed Use of Building:ADULT FAMILY Heat Source: OGas ❑EI ctric ❑Other <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: OCommercial DAccessory Structure <br /> Type of Project: :New ©Addition ©Remodel ❑Repair DTI. ❑Sign OSprinkler ODemolition ❑change of Use <br /> DESCRIPTION OF WORK: 4___ <br /> .ikttr.k.. _ <br /> \ 4, ,Q....44,21 .... <br /> ,� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): se ,-, ��-- <br /> MECHANICAL PERMIT APPLICATION ` PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures ° List of Fixtures Fixture FiList of Fixtures Ore List of Fixtures <br /> Count Count Count Count <br /> A/C—Air Handling Units Gas Piping Backflow reventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes W her Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher 1 Sink-Residential(kitchen,bath,bar) <br /> Duct S tern(Re odel) Refrigeration Drinking Fountai Sink-Utility,laundry,mop <br /> 1 ^Exhaust s 'esidential) Commercial Ventilatior Floor Drain 1 Toilet <br /> Exhaust H•• ype I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust H••. ( •- II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust H,•. (Resi.- (-1) Wood Stove Interceptor-Sand/Oil 4k*----- Water Service(behind meter) <br /> Forced '• Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fi s.lace/Insert/Log Roof Drains Water Heater <br /> SPRIN LER/SUPPRESSION SYSTEM Sewage Ejector or Su p Pump Other: <br /> Water Suppressio System J No.of Heads <br /> Chemical Suppre•=ion System No.of Heads <br /> ACKNOWLEDGE ENT 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.lam 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 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Owner/Authors A Si, nature Date <br /> g (Revised 10/f0/201a <br /> J ii &(J U(O L,i) pe --0S9 <br />