1722 HOLBROOK AVE 2021-09-24 - Laserfiche WebLink

IMO IMO BUILDING PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASH INGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Mack Ink Only Please) PROJECT SITE INFORMATION • PROJECT SITE ADDRESS: STREET 1722 Holbrook Ave PARCEL#: 00549401000700 CITY Everett STATE WA zip 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: • (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Gregory C Czizik OWNER MAILING ADDRESS: STREET 1722 Holbrook Ave CITY Everett STATE WA ZIP 98203 OWNER PHONE:720-854-5526 OWNER` EMAIL: greg.CZiZik@gmail.Com CONTRACTOR COMPANY NAME: k0 McO�0C 172-, WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: D OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK:$10,000.00 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:Office/extra room PROPOSED USE OF BUILDING:Additiorlal Bedroom and Bathroom HEAT SOURCE: ©Gas (Electric ❑Other BUILDING TYPE: ©SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ©Remodel ❑Repair ❑T.I. ©Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: Adding interior walls to create a bathroom and bedroom. This is all interior work and no external walls will be moved. ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 authorized in writing from the 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only �73 0/ PERMIT# 52_ I a5 - DoS wnerlAuthoriz nt Sig ure Date (Revised 2/8/2021) 17---