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BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Sire aMhalbM Iv. M418l for submftW and number of copies required for review, <br />WASHINGTON there drop OR ODMpleted application plus al regt8r'4:d sutNTNlW documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />e+.A.IV A^T wenou AT%^U re% A7S ?FT AAtn 1 fEi PWIW-Pttprean I Iw) e%.Smv a.govfpermits <br />(Blare or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 8932 W IAALL DR, EVERETT. WA 96508 PARCEL M. <br />y EVERETT STATE WA zr 98208 <br />SUITEIUNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (If applicable): <br />TENANTIBUSINESS NAME (if non-residential): <br />LEGAL. DESCRIPTION for Tor cxmstrucdon: Short Playsub& Sion: ARBOR GLEN BLOK LOT Lot No.: 25 (attach copy of kx+g tegai description) <br />CONTACT INFORMATION <br />OWNER NAME: MILYON HAYLE & GENET BEZABIH <br />OWNER MAILING ADDRESS: sTREET 8932 W MALL DR <br />cm EVERTT STATE WA ZIP 98208 <br />OWNER PHONE:425.245.3937 <br />1OWNER EMAIL: nTi1iyon.abebe2@gmai1.c0m <br />CONTRACTOR COMPANY NAME: Owner <br />A STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS UCENSE *(REQUIRED): <br />CONTRACTOR ADDRESS: STREET <br />cm STATE Z!P <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR © OTHER (Please Specify) eMD Design Practice <br />CONTACT NAME: <br />E rm i a s H. Kotu <br />CONTACT PHONE: 20&775-1471 <br />CONTACT EMAIL: errnias@emddesignpractice.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 40,000.00 <br />ASSOCIATED LAND USE PROJECT # if applicable): <br />(valuation shall auhrde the prevailing tali market value of all labor, materials. and equipment needed to complete ft work Whether actually Pad or not) <br />EXISTING USE OF BUILDING: SFR <br />PROPOSED USE OF BUILDING: AFH <br />HEAT SOURCE: ❑J Gas ❑Electric ❑Other <br />BUILDING TYPE: ©SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory str icture <br />TYPE OF PROJECT (check all that apply) : ( New Construction ❑Addition ©Remodel ❑Repair ZT.I. ❑Change of Use <br />❑Modular ❑Portable ❑Re -roof ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure <br />❑Fence over 7ft high ❑RackStorage ❑PoollHot Tub ❑Tank (above ground) ❑Other. Garage conversion <br />DESCRIPTION OF WORK: <br />Interior work includes: Middle and Lower level & garage conversation and to also <br />modify the existing 1/2 bath to a full bath and-aetara. In addition to create a new <br />entry. Exterior work includes: New ramp for the new entry <br />ACKNOWLEDGEMENT.- t have reviewed this application and conrum the lntomration contained herein is true and correct. Wak done pursuant to this pemri must amply with <br />current federal, slate, and local law. The granting of a permit only authorizes approved work and no devfallons therefrom. Deviations must first be autiodwd In writing firm the <br />Building Official before being authorized under any circumstance. l am the owner, or 1 am authorized by the owner of this property to perform the wont for which app#catron is made, <br />and t comply with the Itt. Contract rs Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Onty <br />/ / .__ <br />oz o8 ,'ozz P IT# <br />OwrierlAuth r <br />d Agerrt Si attire Date (Revi 2l82021) <br />l� <br />