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r I" <br />r�igmoalm <br />PERMIT APPLICATIOPO <br />BUILDINGOECHANICAL / PLUMBING / SIGNRINKLER /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: 16 76TH ST SW <br />PROPERTY TAX #: 0039355000001 05 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: HABTYIMER MULU A TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 16 76TH ST SW <br />CITY EVERETT STATE WA ZIP 98203-6350 <br />OWNER PHONE: 2066284174 <br />1OWNER EMAIL: ITIUIUhabtyimer@gmall.C011l <br />CONTRACTOR NAME: Asap restore & Repair LLC <br />CONTRACTOR ADDRESS: STREET 12613 SE 237th PL <br />CITY Kent STATE WA ZIP 98031 <br />CONTRACTOR PHONE: 2062612418 <br />CONTRACTOR EMAIL: Asaprestorel@gmail.com <br />CONTRACTOR LICENSE #(REQUIRED): 604009704 <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 604009704 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR POTHER (Please Specify) <br />CONTACT NAME: <br />JOEY PEREZ <br />CONTACT PHONE: 2062407006 <br />CONTACTEMAIL: DRAFTNW GMAIL.COM <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: RESIDENCE <br />Contract Price of Work: $ 20,000 <br />Proposed Use of Building: ADULT FAMILY HOME <br />Heat Source: Il GaS El Electric ❑other <br />Building Type: BSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: []New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />CONVERT LIVING ROOM TO 2 BEDROOMS <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING 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 />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. 1 am the owner, or / am authorized by the owner of this property to perform the work for which application is made, <br />and I comply witb4he State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Agent <br />re <br />Date <br />City of Everett Official Use Only <br />PERMIT V�D <br />J <br />(Revised 912312016) <br />�y, <br />