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4ETT • PERMIT APPLICATION. <br /> BUILDING I MECHANICAL I PLUMBING /SIGN I SPRINKLER I 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: 1215E casino RD everett wa, 98203 PROPERTY TAX#: 00393600401402 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: WOLDE TESFAYE TGEBREAMANUAEL ALEMTSEHAY M TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1215E casino RD <br /> c,n EVERETT STATE WA 2,p 98203 <br /> OWNER PHONE: (206) 946-0871 OWNER EMAIL: tespa©yahoo.com <br /> CONTRACTOR NAME: TBD <br /> CONTRACTOR ADDRESS: STREET TBD <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 ❑ CONTRACTOR �tTOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2062407006 <br /> JOSE PEREZ CONTACT EMAIL: DRAFTNWAGMAIL.COM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ADULT FAMILY HOME Contract Price of Work:$ 80,000 <br /> Proposed Use of Building; ADULT FAMILY HOME Heat Source: eGas ❑Electric DOther _ „ <br /> Building Type; OSFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: _ ❑Commercial °Industrial <br /> Type of Project: ©New ❑Addition ❑Remodel ElRepair OT.i. ❑Sign OSprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK; <br /> Garage convertion to 3 bedrooms w/ living rm and bath & convert family rm to kitchen for AFH <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #°f List of Fixtures #°f 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:I have reviewed this application and confirm the information contained herein Is two 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wititlhe-State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �✓_.___. City of Everett Official Use Only <br /> .. PERMIT#__ <br /> ( 212/14/2021 i-7 2 Dot D <br /> Owner/AU horIzed A ent I nature _ _-' Date (Revised 9/23/2016) <br /> / I <br />