510 MADISON ST 2022-02-15 - Laserfiche WebLink

Elm III PERMIT APPLICATION• Ira BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:510 MADISON ST. EVERETT, WA 98203 PROPERTY TAX#:00393300001503 LEGAL for new construction: Short Plat/subdivision BEVERLY HILLS DIV 5 BLK 000 D-03 Lot No. 15 (attach copy of long legal description) CONTACT INFORMATION / OWNER NAME: Bah Gavin TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET510 MADISON ST. car EVERETT STATE WA ZIP 98203 OWNER PHONE: 425 760-9423 OWNER EMAIL: CONTRACTOR NAME:WORK TO BE COMPLETED BY THE OWNER CONTRACTOR ADDRESS: STREET CITY \ STATE ZIP CONTRACTOR PHONE: ", CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): \ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR it OTHER(Please Specify) APPLECANT CONTACT NAME: CONTACT PHONE:206 419-709 MAZEN WALLAIA CONTACT EMAIL:mazen.aborami@gmail.com BUILDING INFORMATION Existing Use of Building:Single family residence Contract Price of Work:$5,000 Proposed Use of Building:Adult Family Home Heat Source: ❑Gas DElectric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: New Addition 17/Remodel [I Repair ❑T.l. flSign\,, ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: ELECTRICAL PERMIT. RENOVATIN EXITINGATHROOM THIS WORK INCLUDES RELOCATING TWO POWER OWTLET, ABAND EXISTING HEATER/,AND INSTALL NEW HEATER ASSOCIATED BUILDING PERMIT#(if applicable): Ritildin& Plumbing Permits MECHANICAL PERMIT APPLICATION / PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping/ Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Rant Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pup&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrige ation Drinking Fountain Sink-Utility,laundry,mop i Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil \ Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System // No.of Heads ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Mayen Wallaia Cboaiq signed by Mayen wanaia Date:2020.09.3013.33.41-01'00' 9/30/2020 Owner/Authorized Agent Signature Date (Revised 10/10/2018)