2421 81ST PL SE 2022-10-07 - Laserfiche WebLink

BOLDING PERMIT APPLICATION 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 l(E)everetteps@everettwa.gov l(W)everettwa.gov/permits (Blue:oc Black Ink Oily Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2421 81ST PL SE PARCEL#: CITY EVERETT STATE WA ZIP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):HOMEOWNER LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION a'" OWNER NAME:BEREKET ABRAHAM OWNER MAILING ADDRESS: STREET 2421 81 ST PL SE crry EVERETT STATE WA ZIP 98203 OWNER PHONE:360 723 2907 OWNER EMAIL: bereket1973@gmail.com CONTRACTOR COMPANY NAME:HOMEOWNER WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: El OWNER r ONTRACTOR [THER(Please Specify) CONTACT NAME: CONTACT PHONE:360 723 2907 BEREKET ABRAHAM CONTACT EMAIL:bereket1973@gmail.com BUILDING INFORMATION VALUATION OF WORK:$30000 ASSOCIATED LAND USE PROJECT#(if applicable):N/A (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:RESIDENTIAL/VACANT PROPOSED USE OF BUILDING:ADULT FAMILY HOME HEAT SOURCE: ✓;as IN lectric Cher BUILDING TYPE: 1/ FR ■ownhouse luplex r �,DU ulti-Family-#Units: [ommercial F,ccessory Structure TYPE OF PROJECT(check all that apply): �ew Construction ,ddition 1151 emodel ✓repair _J.I. ;hange of Use lodular Elortable e-roof xterior Alteration [ank(above ground) r ccessory Structure ence over 7ft high ackStorage ool/Hot Tub ank(above ground) )ther: REMODEL DESCRIPTION OF WORK:Repair and remodel to an existing residential structures. 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 1I2 - Owner/Authorized PERMIT# Agent Signature Date (Revised 2/8/2021) 1/7 .