6214 BROADWAY 2022-06-27 - Laserfiche WebLink

BUI WING PERMIT APPLICATIO 6 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 6214 BROADWAY PARCEL#: 005448011201601 CITY EVERETT STATE WA ZIP 98203 SUITE/UNIT#: NA FLOOR#: NA ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):NA LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:ESTHER MURIGU OWNER MAILING ADDRESS: STREET 6214 BROADWAY cm, EVERETT STATE WA ZIP 98203 OWNER PHONE:4133860055/4133860056 OWNER EMAIL: emurigul©gmail.com, robertwamukoya©yahoo.com CONTRACTOR COMPANY NAME:N/A Owner performing work 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) Designer of record CONTACT NAME: CONTACT PHONE:2065486798 CSL designs CONTACT EMAIL:k.tan76@yahoo.com BUILDING INFORMATION VALUATION OF WORK: $45000 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:Single family home PROPOSED USE OF BUILDING:AdUlt family home HEAT SOURCE: ❑Gas ✓❑Electric ❑Other BUILDING TYPE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑✓Remodel El 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:Convert existing garage into 2 bedrooms, 1 bathroom and 1 laundry room. Build a concrete ramp. Partition family room to create an office. 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 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 PER # 10/5/21 c O2(0 Aoriz Agent Signature Date (Revised 2/8/2021) ` /y