9512 HOLLY DR 2023-06-22 - Laserfiche WebLink

BUILDING PERMIT APPLICATIM CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINQTQN 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) PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 9512 HOLLY DR, EVERETT,WA 98204-2608 PARCEL#: 00378700200502 an EVERETT STATE WA ZIP 98204-2608 SUITE/UNIT#: N/A FLOOR#: N/A ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):N/A LEGAL DESCRIPTION for new construction: Short Plat/subdivision Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:KIHARA AMOS OWNER MAILING ADDRESS: STREET 9512 HOLLY DRIVE cm, EVERETT STATE WA Zip 98204-2608 OWNER PHONE:206 661 2200 OWNER EMAIL: amoskw@yahoo.com CONTRACTOR COMPANY NAME:N/A OWNER DOING THE WORK WA STATE CONTRACTOR LICENSE#(REQUIRED):N/A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N/A CONTRACTOR ADDRESS: STREET N/A cln N/A STATE N/A zip N/A CONTRACTOR PHONE: CONTRACTOR EMAIL: EC rz fln Jj y PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) DESIGNER OF RECORD D of . CONTACT NAME: CONTACT PHONE:206 548 6798 i 1 CSL DESIGNS CONTACT EMAIL:csIdesigns21@gmail.com MAY 12 2022 BUILDING INFORMATION CITY 25,000 hermit Se VICCS VALUATION OF WORK: $ 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: ✓❑SFR ❑TownhouseDuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): New Construction Addition ❑✓Remodel Repair ETA. 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: REMODEL (E) BEDROOM A & B TO CREATE (3) BEDROOMS. REMODEL (E) BEDROOM C TO CREATE (1) BEDROOMS & (1) STORAGE. REMODEL (E) BEDROOM D & BATHROOM B TO CREATE (2) BEDROOMS & (1) BATHROOM. CONSTRUCT A CONCRETE RAMP. ACKNOWLEDGEMENT:1 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 05/2/2022 PER #Z2-OS —C` R Own /Autho zed ent Si ature Date (Revised 4/21/2022)