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• PERMIT APPLICATION! <br /> BUILDING/MECHANICAL/PLUMBING/SIGN I 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 Ploaso) 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 /> cm' EVERETT STATE WA zip 98203-3830 <br /> OWNER PHONE: (OWNER EMAIL: <br /> CONTRACTOR NAME:TBD Ha ct CA_ $,.p-111,ux 5 <br /> CONTRACTOR ADDRESS: STREET <br /> CnY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): \ 1` ,1-(K 6L- 1 -D CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 63 Cf(o 1 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 13 OTHER(Please Specify) AGENT <br /> CONTACT NAME: CONTACT PHONE:425 478 9013 <br /> JUAN MOLATO CONTACT EMAIL:jlmolato@yahoo.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:ADULT FAMILY HOME Contract Price of Work: VI CV <br /> Proposed Use of Building:ADULT FAMILY Heat Source: OGas DElectric DOther _ <br /> BUILDING USE: OSFR DTownhouse ODuplex DADU OMulti-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New ©Addition ©Remodel ❑Repair OT.I. DSign OSprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> ‘1\1\4_,J,1/4a...it.A6,....P ..-- , 414.-s._(_/,,,,,,s% Act.— ,k.k---- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Return Rxture Fixture <br /> Count List of Fixtures Count of Fixtures Count List of Fixtures Countof Fixtures <br /> A/C-Air Handling Units Gas Piping Backflow- - ;rater(Inside Bldg) 1 Sho --'ub,or Combo <br /> Boiler Gas Range Clothes Washe' Si, -Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher 1 ink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> 1 Exhaust Fans(Residential) Commercial Ventilatior Floor Drain 1 Toilet <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/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains ater Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewa• jector or Sump Pump Oth • <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.!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 /> P RMx# <br /> ' qtt; I ? ' ; 1 �Iv �, ZlII -� 0 <br /> Owner/Authors A n Signature Date (Revised 10/10/2018) <br /> to Ms.) INA 0 LA—lb <br />