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ILI • PERMIT APPLICATION. <br /> BUILDING/MECHANICAL/PLUMBING I 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 /> (Blum or Black.Ink Only Ploasm) 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 /> crrr EVERETT STATE WA ZIP 98203-3830 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:TBD {-twit( DVD.fir S <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: (CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): H q-A.(14,f6 I.01.2p CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): t,3 (p 7 <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ElOTHER(Please Specify) AGENT <br /> CONTACT NAME: CONTACT PHONE:425 478 9013 <br /> JUAN MOLATO CONTACT EMAIL:jimolato@yahoo.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:ADULT FAMILY HOME Contract Price of Work:$100000' 1 c7(10 <br /> Proposed Use of Building:ADULT FAMILY Heat Source: C)Gas DElectric ['Other __ <br /> BUILDING USE: OSFR ['Townhouse ['Duplex OADU ['Multi-Family-#Units: ['Commercial ['Accessory Structure <br /> Type of Project: [New ©Addition ©Remodel ❑Repair OT.I. ['Sign ['Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> O - k �� <br /> ASSOCIATED BUILD PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATI• PLUMBING PERMIT APPLICATION <br /> Flxfure FIMum Fixture Fixture <br /> Cou List of Fixtures Coats ': of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C-Air Handling Units =as Piping Backflow Preventer(Inside Bldg) 1 Shower,Tub,or Combo <br /> •iler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Cl. .es Dryer Heat Pump&Ductless Dishwasher 1 Sink-Residential(kitchen,bath,bar) <br /> Duct tem(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> 1 Exhaust -'s(Residen'. Commercial Ventilatior Floor Drain 1 Toilet <br /> Exhaust Hoo. 'I pe (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Ty,- I Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood `esideri 1 Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air S tems Other: Medical Gas Water Valves or Fixtures <br /> Gas Firep=ce/Insert/Log Roof Drains Water Heater <br /> SPRIN ER/SUPPRESSION S M Sewage Ejector or Sump Pump Other: <br /> Water Suppre •n System No.of Hea <br /> Chemical Su,.ression System L No.of Heads <br /> ACKNO EDGEMENT..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 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Pr#„&k <br /> /I t; i 2-0';'''I <br /> Owner/Authori A n Signature Date (Revised 10/10/2018) <br /> \, j UI (J 1 00Lio i b <br />