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r 47.7. <br /> PERMIT APPLICATION <br /> BUILDING , I:ULCHANICAL / PLUMBING / SIGN /gMINKLER/ 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: ;,,,,i,_,.,, et ',.,...,-Unit 14D PROPERTY TAX#: n05757001 0190, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Iv1VM Development and Construction TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 19528 Ventura Boulevard, Suite 573 <br /> CITY Tarzana STATE CA Z,E 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: 0 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(RE,QUIRED): 59- <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR I OTHER(Please Specify) t\ Ci'UISCl <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: $ 10i000 <br /> Proposed Use of Building: Tnwnholtse Heat Source: ❑Gas CElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change 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 63 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 /> 1 Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> Range Hood 1 Water Heater Other <br /> 2 Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT:/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 /> �lt,2-c.? <br /> �jCittyy of Everett Official Use Only <br /> / ►4a S • I I <br /> JPERIT <br /> U �tCJ ®2_- <br /> Owner/A thorized Agent Signature Date (Revised 9/23/2016) <br />