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PERMIT APPLICATION <br />_ <br />BUILDING MECHANICAL / PLUMBING / SIGN / INKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />OL 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 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: 11229 1 9th Avenue SE <br />PROPERTY TAX #: 00574700101903 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Silver Lake TOWnhomes, LLC TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 19528 Ventura Boulevard, Suite 573 <br />ciTv Tarzana STATE CA Z,P 91356 <br />OWNER PHONE: 818-822-6560 <br />1OWNER EMAIL: gmoalem@gmall.COm <br />CONTRACTOR NAME: MVM Development and Construction, Inc. <br />CONTRACTOR ADDRESS: STREET 19528 Ventura Boulevard, Suite 573 <br />c,n Tarzana STATE CA z,P 91356 <br />CONTRACTOR PHONE: 818-822-6560 <br />CONTRACTOR EMAIL: gmoalem@gmail.com <br />CONTRACTOR LICENSE #(REQUIRED): MVNDEVM8730J <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 57753 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR V OTHER (Please Specify) PETER ANDERSON <br />CONTACT NAME: <br />PETER ANDERSON <br />CONTACT PHONE: 206-949-5828 <br />CONTACT EMAIL: PGA.IMAGODELINEO MSN.COM <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />I Heat Source: ❑Gas En Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. VSign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: Gfl it'J�rL��� L"XA! <br />Install new T � �� sign. -- ?>wGfotad <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration <br />_Repair <br />Type of Project: _New _Addn <br />_Alteration _Repair <br />#of <br />Fixtures <br />List of Fixtures <br />#of <br />Fixtures <br />List of Fixtures <br />#of <br />Fixtures <br />List of Fixtures <br />#of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />I <br />INo. 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. / am the owner, or 1 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 />Peter Anderson 11-28-18 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 912312016) <br />`AL <br />