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PERMIT APPLICATION <br /> 11.1 BUILDING illiCHANICAL/ PLUMBING /SIGN /•INKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (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:2105 Jefferson Place PROPERTY TAX#:00512300000902 <br /> LEGAL for new construction: Short Plat/subdivision Maynards Plat Lot No.9/10 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Teowdros Negash Gebrehanna TENANT BUSINESS NAME(Commercialkeo <br /> OWNER MAILING ADDRESS: sTREET2105 Jefferson Place 5c7;4— <br /> CITY Everett STATE WA ZIP 98203 <br /> OWNER PHONE: OWNER EMAIL:teogebrehanna@gmail.com <br /> CONTRACTOR NAME:Unknown 0-1/1/4)1(\Q)(-- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑✓ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.377.8786 <br /> Martin Reimers, / Concept CONTACT EMAIL:mreimers@conceptarchitecture.com • • <br /> BUILDING INFORMATION <br /> Existing Use of Building:R-3 Contract Price of Wt 1 _ <br /> Proposed Use of Building:R-3 Heat Source: IZIGas DElectric DOther <br /> BUILDING USE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Remodel existing adult family home <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fix res Count List of Fixtures Count List of Fixtures <br /> c—Air Handling Units Gas Pipi Backflow Preventer(Inside Bldg) 1 Shower,Tub,or Combo <br /> Boiler Gas ge Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes b er He Pump&Ductless Dishwasher 1 Sink-Residential(kitchen,bath,bar) <br /> Duct Syste Remodel) efrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> 1 Exhaust Fans "esidential) Commercial Ventilation Floor Drain 1 Toilet <br /> Exhaust Hood(Ty.- I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Resident!: Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/ •g Roof Drains Water Heater <br /> SPRINKLER/ PPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression Syste _ No.of Heads <br /> Chemical Suppression S, tern No.of Heads <br /> 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 <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.lam the owner,or lam 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 /> �J City of Everett Official Use Only <br /> Martin Reimers ,, ,,m °�-�-•�-� -�°�^�^� 02/12/2021 � v <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />