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477 PERMIT APPLICATIONdk <br /> BUILDINGINECHANICAL / PLUMBING / SIGN I RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I (E)everetteps@everettwa.gov 1 www.everettwa.gov!permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1004 110TH PL SE, EVERETT, WA 98208 PROPERTY TAX#: 0076250000-1000 <br /> LEGAL for new construction: Short Plat/subdivision LARSEN PARK DIV 1&2 Lot No. 10 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: MULATU YIRBA TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 1004 110TH PL SE <br /> clry EVERETT STATE WA ZIP 98208 <br /> OWNER PHONE: 206-697-9981 OWNER EMAIL: MULATUSH@GMAIL.COM <br /> CONTRACTOR NAME: TBD <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> L <br /> )IVTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER (Please Specify) Residential Designer <br /> CONTACT NAME: CONTACT PHONE: 206-6832395 <br /> CARMELO N LAVISTE CONTACT EMAIL: cnldesign.drafting@gmail.com <br /> BUILDING INFORMATION <br /> 'Existing Use of Building: Residential Contract Price of Work: $_40000.00 <br /> Proposed Use of Building: Adult-Family Home Heat Source: OGas Electric ❑Other <br /> BUILDING USE: ❑SFR Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: ENew CAddition CRemodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Convert existing garage into 4 bedrooms, Interior alterations and converting existing lower floor <br /> Single-Family Residence into an Adult-Family Home <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> ,4______ <br /> A/C—Air Handling Units Gas Piping \Backflow Preventer(Inside Bldg) 1 Shower,Tub.or Combo <br /> " Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> 1 Clothes Dryer Heat Pump&Ductless Dishwasher 2 Sink-Residential(kitchen,bath.bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain /' Sink-Utility, laundry, mop <br /> 2 Exhaust Fans(Residential) Commercial Ventilation Floor Drain 1 Toilet <br /> Exhaust Hood(Type I) - (Not Heat/AC system) Hose Bibb \ Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> _ Exhaust Hood(Residential) Wood Stove Interceptor-Sand/ Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Draiois 1 Water HeaieT— <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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. 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 /> PER, IT o )I I () <br /> q?D 1 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />