510 MADISON ST 2022-02-15 - Laserfiche WebLink

® 1110 PERMIT APPLICATION• 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 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 Gavina TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 510 MADISON ST. cirr 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 D 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 1,\O Cnqt,. S'c'L Heat Source: ❑Gas DElectric ❑Other BUILDING USE: IUSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Licommerciai ❑Accessory Structure Type of Project: ❑New Addition [(Remodel LIIRepair ❑T.I. ElSign Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: BUILDING PERMIT. RENOVATIN EXITING BATHROOM BY RELOCATING THE BATHROOM DOOR AS SHOWN ON THE PLANS scec,\.4; gi_e4 ASSOCIATED BUILDING PERMIT#(if applicable): Flectrical & 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 NC—Air Handling Units Gas Piping Backfow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop 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:I 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 lam 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 PER T#� �,r-� Mazen Wallaia OgitaYysgneahy Mazen Wallaa 9/30/2020 -S5 Owner/Authorized Agent SignatureaE Zozoo93o,333<,-oroo Date (Revise 0/10/2018) yz_