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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> "111111* <br /> '41111W1 <br /> 1111 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: 125 74th street SE PROPERTY TAX#: 00392000002306 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION' <br /> OWNER NAME: ALGANESH GHEBRE&HERMONA TEKESTE TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 125 74TH STREET SE <br /> CITY EVERETT STATE WA ZIP 98023 <br /> OWNER PHONE: 206-753-8736 OWNER EMAIL: <br /> CONTRACTOR NAME: HOMEOWNER <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: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) DESIGNER <br /> CONTACT NAME: CONTACT PHONE: 206-6832395 <br /> CARMELO N. LAVISTE CONTACT EMAIL: bongnlAhotmail.com <br /> BUILDING:PERMIT-APPLICATION <br /> Existing Use of Building: SINGLE FAMILY Contract Price of Work:$ 2000 <br /> Proposed Use of Building: ADULT FAMILY HOME Heat Source: ❑Gas ZJElectric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition I2Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 6,A-6 fM, 1 Ern- , Ti , `6 f -,-Gla <br /> hand 'Yeti IS. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type,f Project: New Addn _Alteration ..air Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #of st of Fixtures #of � t of Fixtures #of List of F'-•res <br /> Fixtures Fixtures _ Fixtures Fixtures <br /> A/ Air Handling Units Heat Pump Toilet Backflow -venter(Inside Bldg) <br /> Force. •,ir Systems Unit Heater Bathtub Urin. <br /> Gas Piping Boiler Lavatory(Wash Basi % inking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher 'oof Drains <br /> Clothe %ryer Hookups Other: Clothes Was - Me.'...I Gas <br /> R.••e Hood Water ='er Other: <br /> xhaust Fan Si ervice/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water ' 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 /> 1 I io PERMIT#e)t ' <br /> Owner/Authorized Agent Signature D e (Revised 9/23/2016) <br /> t/Z <br />