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477- PERMIT APPLICATIO <br /> BUILDING I MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT.WA 98201 <br /> (P)425-257-8810 I 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: 10317 HOLLY DR, EVERETT, WA 98204-3721 PROPERTY TAX#: 00552300200502 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TOLESSA TESFAYE L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 10317 HOLLY DR <br /> CITY , EVERETT STATE WA ZIP 98204-3721 <br /> OWNER PHONE: 2067782107 OWNER EMAIL: covenanthomel3@yahoo.com <br /> CONTRACTOR NAME Bernard Fajarillo - -50 iii,, <br /> CONTRACTOR ADDRESS: STREET 23005 76th. ave w <br /> CITY Edmonds STATE WA ZIP 98037 <br /> CONTRACTOR PHONE: 2067954032 -----.CO(( (( OR EMAIL: asaprestorel@gmail.com <br /> CONTRACTOR LICENSE#(REQUIRE ): V—c. F EVERETT BUSINESS LICENSE#(REQUIRED): Q� p J l <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR wOTHER (Please Specify) DRAFTER <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: $ �.. 1�7 'C1(--) Z6L O 5 <br /> Proposed Use of Building: ADULT FAMILY HOME Heat Source: ❑Gas DElectric DOther <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew DAddition DRemodel DRepair ❑T.l. ❑Sign ❑Sprinkler DDemolition 11rChange of Use <br /> DESCRIPTION OF WORK: <br /> Convert to Adult family home <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 List of Fixtures <br /> Fixtures Fixtures _ Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> _Forced Air Systems Unit Heater Bathtub Urinal <br /> •Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> •Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap <br /> Gas Range _ Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups _ Other: Clothes Washer Medical Gas <br /> •Range Hood Water Heater Other <br /> .Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT I have reviewe• is 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. ' e 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 au•.rized 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 complyt with the State .ntractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ) PERMIT# <br /> Joe. '� �`�z 4/22/19 ��9�� � <br /> Owner/AuthorizAgent Signature Date (Revised 9/23/2016) <br /> 17 <br />