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BRLDING PERMIT APPLICATIR <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 /> wASIttNGTON 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)PermitServices@everettwa.gov I(VV)everettwa.gov/permits <br /> (Blue or Black Ink Only-Please) , PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 3308 Rockefeller Ave PARCEL#: 00436979202900 <br /> CITY Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Basement to ADU <br /> TENANT/BUSINESS NAME(if non-residential):3308 Rockefeller Ave LLC <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:3308 Rockefeller Ave LLC <br /> OWNER MAILING ADDRESS: STREET P O Box 1094 <br /> tiny Woodinville STATE WA ZIP 98201 <br /> OWNER PHONE:425.244.0007 OWNER EMAIL: ismail.seattle@gmail.Com <br /> CONTRACTOR COMPANY NAME:TBD \fl n b v(x,0 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): N I JOVT L-8a 0 T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 2 7 5 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: E OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.244.0007 <br /> Ismail Mohammad CONTACT EMAIL:ismail.seattle@gmail.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$42,500 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:SFR <br /> PROPOSED USE OF BUILDING:Basement Conversion to an ADU <br /> HEAT SOURCE: ❑Gas ❑✓Electric ❑Other <br /> BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units:1 ❑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 ElTank(above ground) ❑✓Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ETank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Basement to be converted to ADU. No changes to the existing unit or Building <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 gra ' rmit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under an 'rcumstance.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 Contracto La 1 . W and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ►t August 23rd,zoz2 PERMIT# <br /> Owner/Autho Ignature Date (Revised 4/21/2022) <br />