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• PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />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: 1502 100TH ST SW EVERETT WA 98204 <br />PROPERTY TAX #: 00552400600700 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION` <br />OWNER NAME: BELETE HIRRA TENANT BUSINESS NAME (Commercial): ELDANA AFH LLC <br />OWNER MAILING ADDRESS: STREET 1502 100TH ST SW <br />CITY EVERETT STATE WA ZIP 98204 <br />OWNER PHONE: (206)571-9533 <br />OWNER EMAIL: BELETE.HIRRA@YAHOO.COM <br />CONTRACTOR NAME: BY OWNER <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR El OTHER (Please Specify) WIFE <br />CONTACT NAME: <br />SIMEGN BIWETA <br />CONTACT PHONE: (206)582--9309 <br />CONTACT EMAIL: SIMEGNB3@GMAIL.COM <br />BUILDING INFORMATION <br />Existing Use of Building: lContract <br />Price of Work: $ 4500.00 <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric []Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ✓❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel []Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: Remove Bathtub fix Bathroom Grb born & Bathroom Swing up Grab bor <br />New Hand Insswing Double Door French patio Door <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C —Air Handling Units <br />Gas Piping <br />jBackflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />IClothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat PumpBDuctless <br />I Dishwasher <br />Sink -Residential (kitchen, bath, bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />INC. of Heads <br />Chemical Suppression System <br />I <br />No. of Heads <br />ACKNOvvLEDGEMLiv t: i have ad 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 /oc w. e granting of a mlt only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before bein uthoriz under any Circ stance. 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 ontract aw 18.27 RC 296.200A WAC. <br />City of Everett Official Use Only <br />of iza/2 t PE # <br />Owner/Authorized Agent Signature Date (Revised 1011012018) <br />