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BOLDING PERMIT APPLICA1N <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 5113 Beaumont Dr. PARCEL#: 00377500002000 <br /> crry Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: ALTA VISTA Lot No.:20 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Rediet Yirdaw&Abeba Mulat <br /> OWNER MAILING ADDRESS: STREET Same as above <br /> CRY STATE ZIP <br /> OWNER PHONE:206-734-2364 OWNER EMAIL: sabamulate@yahoo.com <br /> CONTRACTOR COMPANY NAME:OWner <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> crrY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: D OWNER ❑CONTRACTOR ✓°OTHER(Please Specify) eMD Design Practice <br /> CONTACT NAME: CONTACT PHONE:206-775-1471 <br /> E rm t a s }-' •a I I U CONTACT EMAIL:'Crmias@emddesignpractice.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$5OK ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shalt include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: SFR <br /> PROPOSED USE OF BUILDING:AFH <br /> HEAT SOURCE: ✓I 3Gas DElectric ❑Other <br /> BUILDING TYPE: I SFR °Townhouse ❑Duplex °ADU ❑Multi-Family-#Units: °Commercial °Accessory Structure <br /> TYPE OF PROJECT(check all that apply): °New Construction °Addition °Remodel ❑Repair ET.I. ❑Change of Use <br /> °Modular °Portable ORe-roof °Exterior Alteration °Tank(above ground) DAccessory Structure <br /> OFence over 7ft high °RackStorage ❑PoollHot Tub °Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Interior work (Upper level only) includes: To modify and remodeling the existing upper <br /> level for the purpose used for AFH. The work willconsist of modification <br /> andremodelingof the existing bathroom & bedrooms, replacing all bedroom windows <br /> and all doors. (Lower Level Only): To remove large closet in the family room. To <br /> replace existing bathroom partition wall with a normal wall. (Exterior Work): New ramp <br /> for the main entry. <br /> 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 <br /> 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 <br /> Building Official before being authorized under any circumstance./am the owner,or i am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> j, A► City of Everett Official Use Only <br /> 12) J W 2 PERMIZZ20?) OO <br /> \\ner/Authors ed Age Signature Date (Revised 2/8/2021) <br /> III <br />