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PERMIT APPLICATIOI <br /> 477- BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ��( Unit 15E PROPERTY TAX#: 005 75 7 001 01 902, <br /> - ` �" 00575700101q03 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> t\(rZ 1 Jake_ k RM4T40. ,1__ - <br /> OWNER NAME: • .4 •- '- •••-- .n• ons • .. - TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 19528 Ventura Boulevard, Suite 573 <br /> CITY Tarzana STATE CA Zip 91356 <br /> OWNER PHONE: 818-822-6560 OWNER EMAIL: gmoalem@gmail.com <br /> CONTRACTOR NAME Same as above <br /> CONTRACTOR ADDRESS: STREET <br /> CITY <br /> STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):S9 S <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER (Please Specify) Architect <br /> CONTACT NAME: Peter Anderson CONTACT PHONE: 206-949-5828 <br /> CONTACT EMAIL: pga.imagodelineo@msn.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Vacant property Contract Price of Work: $ 100,000 <br /> Proposed Use of Building: Towrihollce Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> Construct new three story Townhouse <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 <br /> — — <br /> Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures #of <br /> Fixtures Fixtures List of Fixtures <br /> Fixtures <br /> A/C–Air Handling Units Heat Pump 4 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 6 Unit Heater 2 Bathtub Urinal <br /> Gas Piping Boiler 5 Lavatory (Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration 1 Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink& Disposal Grease Trap <br /> Gas Range Ducting 1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> Range Hood 1 Water Heater Other: <br /> Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water I 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 Stat ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �, ) 1 PERI�pIT <br /> ---- • .2 -- oz.2_ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />