1504 108TH ST SW 2022-05-06 - Laserfiche WebLink

111) • Len BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS_See applicable submittal checkl•st 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)425.257.8810I(E)everetteps@everettwa.gov I(W)everettwa.gow,permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1504 108TH ST SW PARCEL#: 00442800000400 cr., EVERETT STATE WA 71P 98204 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short PIatisubdivis:on: Fairhaven acres Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:EYERUSALEM MAIRD OWNER MAILING ADDRESS: STREET 1504 108TH ST SW c„ EVERETT STATE WA TiP 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: (p.{US)S . FF�� S IhhY 1/cl/t t�h SO4'N t S WA STATE CONTRACTOR LICENSE#IREQUIRFD):(, .0 �A C,01-1- e,CITY OF EVERETT BUSINESS LICENSE#(REOLIRED): Ce 117 5 CONTRACTOR ADDRESS: STREET CITY SiA,E 4P CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.377.8786 MARTIN REIMERS, AIA CONTACT EMAIL:MREIMERS©CONCEPTARCHITECTURE.COM BUILDING INFORMATION VALUATION OF WORK:S30000 ASSOCIATED LAND USE PROJECT#(if applicable): i\•aluaEon shall include the prevailing fair market value of all labor,materials.and equipment needed to complete the work,whether actually ea d or not.) EXISTING USE OF BUILDING:RESIDENCE PROPOSED USE OF BUILDING:RESIDENCE HEAT SOURCE: [;:'..]Gas CElectric [Other BUILDING TYPE: ❑✓SFR ❑Townhouse CDuplex ❑ADU L_1Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check ail that apply): CNew Construction CAdd tion E Remodel ❑Repair ❑T.I. Lr✓_Change of Use I 'Modular CPortable I iRa-roof riExterior Alteration (Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high !1RackStorage ❑PooliHot Tub ElTank(above ground) ❑Other-_ DESCRIPTION OF WORK:CONVERT GARAGE INTO LIVING SPACE FOR ADULT FAMILY HOME. ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work clone pursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authonzes approved work and no deviations therefrom.Deviations must first be authonzed in writing from the Building Official before being authorized u• circumstance.f am the owner,or I am authorized by the owner of this property to perform the work for which application lb made, and l comply with the State •ntracto • RCW and 296.200A WAC. City of Everett Official Use Only 'VP- PERMIT# � or/ A�� 07f27/2021 Owner/Autrnt Signature Date (Revised 2/8/2021) /�