1715 HOLBROOK AVE 2021-12-16 - Laserfiche WebLink

EtILDING PERMIT APPLICATTN CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON 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 Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1715 Holbrook Ave PARCEL#: 00549400601600 CITY Everett STATE WA ZIP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION new construction: Short Plat/subdivision. Lot No (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:David Miller & Unju Kim OWNER MAILING ADDRESS: STREET 1715 Holbrook Ave. CITY Everett STATE WA ZIP 98203 OWNER PHONE:206-841-2454 OWNER EMAIL: sunriceuusunrice.net CONTRACTOR COMPANY NAME: N/A WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify)CONTACT NAME: CONTACT PHONE:206-841-2454 Unju Kim CONTACT EMAIL:Sunriceuu@sunrjce.net BUILDING INFORMATION VALUATION OF WORK:$12,000 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the pre ling fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:single family dwelling PROPOSED USE OF BUILDING:same as above HEAT SOURCE: ❑✓Gas ❑Electric ❑Other BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑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 a bathroom in the existing laundry/storage room. a wall will be built to define the bathroom and laundry room. an exhaust fan will be installed on the ceiling. 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 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/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 5/ PERMIT# 2��I2i PZl03 - 0 3 Owner/Authorized Agent Signature Date (Revised 2/8/2021) /Z