2105 JEFFERSON PL GEBREHANNA ADULT FAMILY HOME 2022-06-28

PERMIT APPLICATION BUILDINGOECHANICAL/ PLUMBING /SIGN /•RINKLER/ 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:21 05 Jefferson Place PROPERTY TAX#:0051 2300000902 LEGAL for new construction: Short Plat/subdivision Maynards Plat Lot No.9/10 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Teowdros Negash Gebrehanna TENANT BUSINESS NAME(Commercial) �JS�" k OWNER MAILING ADDRESS: STREET2105 Jefferson Place CITY Everett STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL:teogebrehanna@gmail.com CONTRACTOR NAME:U n known CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.377.8786 Martin Reimers, / Concept CONTACT EMAIL:mreimers@conceptarchitecture.com • BUILDING INFORMATION Existing Use of Building:R-3 Contract Price of W :$ Proposed Use of Building:R-3 Heat Source: OGas ❑Electric ❑Other BUILDING USE: IZISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Remodel existing adult family home ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATI GIN 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 -venter(Inside Bldg) 1 S >" er,Tub,or Combo Boiler Gas Range Clothes Was -r ink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher 1 Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop 1 Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1 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 v = -r Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Eject. 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 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 PE IT Martin Reimers m ffi,p:,,,,,,,�„ �-+-� 02/12/2021 2 b�-1 - 6(0 i Owner/Authorized Agent Signature Date (Revised 10/10/2018)