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

� PERMIT APPLICATIO BUILDING%MECHANICAL / 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 www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:2105 Jefferson Place PROPERTY TAX#:00512300000902 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)( (onSt kiosk- OWNER MAILING ADDRESS: sTREET2105 Jefferson Place CITY Everett STATE WA zIP 98203 OWNER PHONE: OWNER EMAIL:teogebrehanna@gmall.Com CONTRACTOR NAME:U nknoWn O r Pr CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.377.8786 Martin Reimers, / Concept CONTACT EMAIL:mreimers@conceptarchitecture.com BUILDING INFORMATION ®,F, Existing Use of Building:R-3 Contract Price of W ©1 V DQ.t)y i Proposed Use of Building:R-3 Heat Source: IZGas DElectric ❑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 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) 1 Shower(Tub,or Combo Boiler Gas Range Clothes Washer Sink/Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher 1 nk-Residential(kitchen,bath,bar) Duct stem(Remodel) ffefrigeration Drinking Fountain Sink-Utility,laundry,mop 1 Exhaus ans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust od(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Ho (Type II ' Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood e • ential) Wood Stove Interceptor-Sand/Oil / Water Service(behind meter) Forced Air Sys Other: Medical Gas ater Valves or Fixtures Gas Firepl e/lnsert/Log Roof Drains Wa ater SPRIN ER/SUPPRESSION SYSTEM Sewage Eject or Sump Pump Other: Water Suppres ' n 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 7;Martin Reimers 02/12/2021 PE C(9 2 Owner/Authorized Agent Signature Date (Revised 10/10/2018) / I