1706 112TH ST SE 2023-10-26 - Laserfiche WebLink

BIDDING PERMIT APPLICAT& CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON 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 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1706 112th Street SE PARCEL #: 00494200401401 CITY EVERETT STATE WA ziP 98204 SUITE/UNIT #: FLOOR #: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: MYRNA BREWER TRUST OWNER MAILING ADDRESS: STREET 1706 112TH STREET SE crrr EVERETT STATE WA ZIP 98204 OWNER PHONE: 206-474-7492 OWNER EMAIL: anislaralyn20ll@gmail.com CONTRACTOR COMPANY NAME: HOMEOWNER WA STATE CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑✓ OTHER (Please Specify) DESIGNER CONTACT NAME: CARMELO N LAVISTE CONTACT PHONE: 206-6832395 CONTACT EMAIL: cnldesign.drafting@gmail.com BUILDING INFORMATION VALUATION OF WORK: $4 Z; ��3 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 residence PROPOSED USE OF BUILDING: Adult -Family Home HEAT SOURCE: ❑✓ Gas ®Electric ❑Other BUILDING TYPE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑✓ Addition ❑✓ Remodel ❑Repair ❑T.I. ❑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: Convert existing garage into two bedrooms, bathroom and utility room, Add 98 SF bedroom exterior addition, Interior alterations, exterior ramp w/ wrollV� conversion of an existing SFR into an Adult -family home. D JUN 22 2022 Inc ETT %J 1 1 I — 4} pp Q ACKNOWLEDGEMENT_ I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to`t%i@, mot ,�ry h 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. 6-10-2022 Owner/Authorized Agent Sibnature Date City of Everett Official Use Only PERMIT (Revised 21812021) Z