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0 <br />BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425.257.8810 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 12503 17TH AVE SE PARCEL #: 01069700000600 <br />CITY Everett STATE WA z,P 98208 <br />SUITE/UNIT #: FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Kifle B. Tsegaye and Lidya Kebede <br />OWNER MAILING ADDRESS: STREET 12503 17TH AVE SE <br />CITY Everett STATE WA ZIP 98208 <br />OWNER PHONE:206-267-8805 <br />OWNER EMAIL: kebedeli@msn.com <br />CONTRACTOR COMPANY NAME: <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Kifle B. Tsegaye <br />CONTACT PHONE: 206-267-$$05 <br />CONTACT EMAIL: kebedell@msn.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 8000.00 ASSOCIATED LAND USE PROJECT # if applicable): <br />(Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) <br />EXISTING USE OF BUILDING: backyard <br />PROPOSED USE OF BUILDING: backyard <br />HEAT SOURCE: ❑Gas ❑Electric ❑Other <br />BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br />❑Modular ❑Portable ❑Re -roof ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure <br />❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑✓ Other: uncovered deck <br />DESCRIPTION OF WORK: <br />Building uncovered 12x24 deck. The deck will be built by the owner. <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT #02-1 <br />Owner/Arized AVerrt Signature ate (Revised 21812021) <br />r <br />\ I <br />