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- • 410 <br /> BUILDING PERMIT APPLICATION <br /> EVERETT CITY TT R <br /> SUBMITTAL INSTRUCTIONS:See applicableOFEVERE submittal checklistPERMITSE for submVICESittal 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 3427 Bell Ave PARCEL#: 00561900101300 <br /> ci-ry Everett STATE WA ZIP 98201 <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: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:James &Yukako Hernandez <br /> OWNER MAILING ADDRESS: STREET 3427 Bell Ave <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE:425-231-0435 OWNER EMAIL: hernandezcapital.11c@gmail.com <br /> CONTRACTOR COMPANY NAME:Owner built <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:210-897-3694 <br /> Robert Smith Mac Donald CONTACT EMAIL:robmav50.rs@gmail.com �'^'��c�•r`j�? <br /> BUILDING INFORMATION Ct.A-U...•CIAA, <br /> VALUATION OF WORK:$10C#0<#.**.:50 C90O ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall 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:Single Family Residential & Unpermitted ADU <br /> PROPOSED USE OF BUILDING:Single Family Residential &ADU <br /> HEAT SOURCE: ❑Gas ❑✓Electric ❑Other <br /> BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑✓Remodel ✓❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑✓Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ElFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: PLY- EKING SIT B2-1$4-9-1$-'ONu:40‹._ <br /> NEW SCOPE TO BE THE FOLLOWING: <br /> - INTERIOR RECONFIGURE AND REMODEL OF EXISTING HOUSE & FINISH OUT <br /> \--DeCer-- DEMOLISH ATTACHED GARAGE INSTALL ELEVATED 14'X14' DECIK.) <br /> OF-TAC I ED G D <br /> ?D ©c‘ -CI--t. a <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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P <br /> P 08/11/2021 \ I O(o 0 <br /> l , <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />