10929 10TH DR SE 2024-01-03 - Laserfiche WebLink

NNE B DING PERMIT APPLICKNION 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 I(E)everetteps@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 10929 10TH DR SE PARCEL#: 00762500001500 CITY EVERETT STATE WA ZIP 98208 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: SEYOUM HAILEYSUS&ASTER MEBRATE OWNER MAILING ADDRESS: STREET 10929 10TH DR. SE CITY EVERETT STATE WA zip 98208 OWNER PHONE: 425-418-6149 OWNER EMAIL: Hailedomenico@gmail.com CONTRACTOR COMPANY NAME: nI %A...74-o -t" - LJ 1Z R 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: CONTACT PHONE: 206-6832395 CARM E LO N LAV I STE CONTACT EMAIL: cnldesign.drafting@gmail.com BUILDING INFORMATION VALUATION OF WORK:$ 150000.00 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: ©SFR ❑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: PROPOSED 2 BEDROOMS & UTILITY ROOM GARAGE CONVERSION,INTERIOR ALTERATIONS, BATHROOM REMODEL,4 BEDROOMS,1-1/2" BATH ADDITION & EXIST.SFR LOWER FLOOR INTO AN ADULT-FAMILY HOME. 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 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 PERMIT# 3 7" I 0 55 Carmelo Laviste Digitally signed by Carmelo Laviste 1 0 Dale 202106.2803.07.31-07'00' 6-28-2021 Owner/Authorized Agent Signature Date (Revised 2/8/2021) i