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grr PERMIT APPLICATIOF. <br /> BUILDIN ECHANICAL / PLUMBING / SIGN NLRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1430 112th ST SE PROPERTY TAX#: 28051900402000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: GEBREYES ELSABET N&YELEMWOSSEN DESTA B TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1430 112th ST SE <br /> CITY EVERETT STATE WA ZIP 98203-6350 <br /> OWNER PHONE: 206-779-601 1 OWNER EMAIL: n.elsabet@gmail.com <br /> CONTRACTOR NAMES T j<5111/4-6;) <br /> CONTRACTOR ADDRESS: STREET Tao <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: TBD CONTRACTOR EMAIL: TBD <br /> CONTRACTOR LICENSE#(REQUIRED): TBD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): TBD <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR VOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2062407006 <br /> JOEY PEREZ CONTACT EMAIL: DRAFTNW@GMAIL.COM <br /> BUILDING PERMIT APPLICATION _ <br /> Existing Use of Building: ADULT FAMILY HOME Contract Price of Work: $ 10, 00 3,77� }'oI <br /> Proposed Use of Building: ADULT FAMILY HOME Heat Source: VJGas- ❑Electric DOther <br /> Building Type: I2fSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel El Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Us <br /> DESCRIPTION OF WORK: <br /> Interiorpartition ,oy <br /> ASSOCIATED BUILDING PERMIT#(if applicable): v� 52 T <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER /SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT:l 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.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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0.73/12 PERMIT ZbC_____ <br /> ,Vc)� i0O i <br /> Owner/Authorized Ag nt Sign e Date (Revised 9/23/2016) i <br />