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PIALIC WORKS PERMIT APLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 2324 100TH ST SE <br />IF APPLICABLE: [—] LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: L7SFR-DETACHED L ISFR-ATTACHED I JDUPLEX CIMULTI-FAMILY 1COMMERCIAL <br />CHANGE OF USE? o NO EAYES, FROM TO <br />NEW WATER / SEWER SERVICE NEEDED? 0 NO O YES, TYPE SIZE <br />SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: CONVERSION OF EXTG FAMILY ROOM TO AN ADDITIONAL BEDROOM <br />o FENCE IN ROW <br />FT IN HEIGHT <br />E-1 DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />I -(ASPHALT/ CONCRETE PAVING <br />SF <br />I-1 RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />FA RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />L-I CLEARING / GRADING / FILL / EXCAVATE <br />CY <br />E:_1 CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />L-I CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACT INFORMATION <br />OWNER NAME: ALEMU SAMUEL G & DESTA HELEN <br />OWNER MAILING ADDRESS: <br />STREET 2324 100TH ST SE <br />CITY EVERETT STATE WA zip 98208 <br />OWNER PHONE: <br />APPLICANT NAME: rAwNannel <br />OWNER EMAIL: helenyosef22@gmail.com <br />APPLICANT MAILING ADDRESS: <br />STREET [AppAdd] <br />CITY [AppCi] STATE [AppSt] ZIP [AppZip] <br />APPLICANT PHONE: [AppPhone] APPLICANT EMAIL: [AppEmail] <br />PRIMARY CONTACT: t-7 OWNER L 1 APPLICANT U OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: KOTU ERMIAS <br />CONTACT PHONE: 2067751471 <br />CONTACT EMAIL: <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br />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 <br />authorized in writing from the Building Official before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to <br />perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />PW2005-022 <br />Authorized Agent/Owner Date (Revised 1011212015) <br />