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4-77 PERMIT APPLICATIO <br /> BUILDINAECHANICAL / PLUMBING / SIGN PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (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 Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 30 W Intercity Ave PROPERTY TAX#: 00480300601512 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Lydia Kebaya TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 130 W Intercity Ave <br /> CITY EVERETT STATE WA Z;R 98204 <br /> OWNER PHONE: 2063495032 OWNER EMAIL: LMORAA53@YAHOO.COM <br /> CONTRACTOR NAME: TBD 0 Wl/ LX' <br /> CONTRACTOR ADDRESS: STREET N/A <br /> CITY N/A STATE N/A zip N/A <br /> CONTRACTOR PHONE: N/A CONTRACTOR EMAIL: N/A <br /> CONTRACTOR LICENSE#(REQUIRED): N/A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N/A <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR pOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2062407006 <br /> JOEY PEREZ CONTACT EMAIL: DRAFTNW@GMAIL.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RESIDENCE Contract Price of Work: $ 60,000 <br /> Proposed Use of Building: RESIDENCE Heat Source: IeGas ❑Electric ❑Other <br /> Building Type: BSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair CT.!. ❑Sign DSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> Add a bonus with bar,office and game area and bath/util . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t-1 ,,,�, „-if= j / --e_c_( <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of Est of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/Ct-Air Handling Units Heat Pump 1 Toilet Backf(ow Preventer(Inside Bldg) <br /> Forced,Air Systems Unit Heater Bathtub` . -Urinal <br /> Gas Pipfttg, Boiler i Lavatory(Wash Basin) Drinking Fountain <br /> Water Heatel I Refrigeration i Shower Floor Drain <br /> Gas Fireplace \, Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting i Dishwasher Roof Drains <br /> Clothes Dryer Hookups ' Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fayt Sink(Service/B / op/etc.) Other: <br /> SPRINKLERLE /SUPPRESSION SYSTEM <br /> Chemical or Water ' 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.I am 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 /> / '± r ��i i /9Zd PERMIZ 21,12— O 2SD <br /> Owner/Authorized A e Signature Date (Revised 9/23/2016) / <br />